LOW-DOSE DOBUTAMINE ECHOCARDIOGRAPHY IS MORE PREDICTIVE OF REVERSIBLEDYSFUNCTION AFTER ACUTE MYOCARDIAL-INFARCTION THAN RESTING SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHIC TL-201 SCINTIGRAPHY

To directly compare dobutamine echocardiography and resting single pho ton emission computed tomographic (SPECT) thallium-201 (Tl-201) scinti graphy for the detection of reversible dysfunction, 64 patients underw ent dobutamine echocardiography (baseline, low dose 5 and 10 mg/kg/min , and peak dose), rest Tl-201 scintigraphy (3 mCi- 15 minute and 3- to 4-hour SPECT imaging), and coronary angiography during the First week after acute myocardial infarction. Follow-up echocardiography was per formed 4 to 8 weeks after discharge. Wall thickening improved at follo w-up in 52% (207 of 399) of the dysfunctional segments. By receiver op erating characteristic analysis, biphasic responses and sustained impr ovement during dobutamine echocardiography were more accurate (p < 0.0 1) than Tl-201 uptake by SPECT scintigraphy for reversible dysfunction . The greater accuracy of dobutamine echocardiography resulted from hi gher accuracy in akinetic segments, Q wave infarction, and multivessel coronary artery disease. In conclusion, dobutamine echocardiography w as more accurate than resting SPECT Tl-201 scintigraphy for reversible dysfunction after acute myocardial infarction.