Concordance between dobutamine Doppler tissue imaging echocardiography andrest reinjection thallium-201 tomography in dysfunctional hypoperfused myocardium

France Objective-To evaluate the efficiency of the new technique colour Dop pler tissue imaging (DTI) by studying the concordance between dobutamine DT I, standard grey scale echocardiography (SE), and rest-reinjection TI-201 t omography (TI) in dysfunctional myocardium. Patients-23 patients with chron ic wall motion abnormalities and proven coronary artery disease (> 70% diam eter stenosis of at least one major coronary artery at angiogram). Methods-The contractile reserve and the resting perfusion characteristics o f dysfunctional myocardial segments were assessed with low dose dobutamine SE and/or DTI (2.5 up to 20 gamma/kg/min) and TI on a semiquantitative basi s. The DTI or SE data were separately compared with TI, on the basis of a 1 3 segment ventricular model. The resulting score of combined DTI and SE was also compared with TI. Finally the results obtained from DTI were compared with SE. Results-A total of 142 severely hypokinetic or akinetic segments were visua lised. The viability study was feasible in 127 (89%) and 121 (85%) segments with DTI and SE, respectively. TI detected viability more frequently than DTI (84 upsilon 61, p < 0.001) and SE (80 upsilon 50, p < 0.001). However, as many viable segments were detected with combined DTI and SE as with TI ( 78 upsilon 84, NS). The Ii values between TI and SE, DTI or combined SE and DTI were 0.38, 0.45, and 0.57, respectively, and France increased to 0.52 and 0.76, respectively, for SE and DTI versus TI when mid-anterior and mid- inferior segments only were considered. The Ic value between SE and DTI was 0.34. Conclusions-DTI is a helpful adjunct to SE, when using low dose dobutamine. This combination revealed as many viable segments as TI and showed a bette r agreement than DTI or SE alone for the assessment of myocardial viable se gments evidenced by TI.