Dobutamine echocardiography predicts functional outcome after revascularisation in patients with dysfunctional myocardium irrespective of the perfusion pattern on resting thallium-201 imaging

Objective-To evaluate whether the predictive value of dobutamine echocardio graphy for assessing contractile reserve was altered by differing patterns of regional myocardial perfusion. Patients-31 consecutive patients with symptomatic congestive heart failure (left ventricular ejection fraction < 35%) caused by coronary artery diseas e. Setting-A district general hospital. Methods-Thallium-201 perfusion imaging and low dose dobutamine (5-15 mu g/k g/min) echocardiography were performed and resting echocardiography was rep eated three months after revascularisation. Perfusion pattern and systolic wall thickening were compared using a 12 segment left ventricular model. Results-Of the 273 severely dysfunctional segments, 106 (39%) showed a norm al perfusion and 167 (61%) an abnormal pattern. After revascularisation, re covery occurred in 71 of the segments with a normal perfusion pattern, and in these a dobutamine response was observed in 61 (86%); recovery also occu rred in 56 segments with a mild to moderate abnormality of perfusion, and i n these a dobutamine response was seen in 46 (81%) (NS). After revascularis ation, the positive and negative predictive values for recovery of dysfunct ional segments, where the majority were abnormally perfused, were 88% and 8 6%, respectively. Systolic wall thickening score indices improved from (mea n (SD)) 3.21 (0.58) to 2.6 (0.66) (p < 0.001) after revascularisation in do butamine responsive patients (n = 24) compared with patients who did not sh ow a dobutamine response (2.86 (0.65) and 3.13 (0.56), p = 0.61, respective ly). Conclusions-Dobutamine echocardiography predicted improvement of dysfunctio nal myocardium after revascularisation irrespective of the resting perfusio n pattern seen.