End-diastolic wall thickness as a predictor of recovery of function in myocardial hibernation - Relation to rest-redistribution Tl-201 tomography anddobutamine stress echocardiography

OBJECTIVE The study assessed whether end-diastolic wail thickness (EDWT), m easured with echocardiography, is an important marker of myocardial viabili ty in patients with suspected myocardial hibernation, and it compared this index to currently established diagnostic modalities of dobutamine stress e chocardiography (DSE) and rest-redistribution thallium-201 (T1-201) scintig raphy. BACKGROUND Because myocardial necrosis is associated with myocardial thinni ng, preserved EDWT may provide a simple index of myocardial viability that is readily available from the resting echocardiogram. \ METHODS Accordingly, 45 patients with stable coronary artery disease and ve ntricular dysfunction underwent rest 2D echocardiograms, DSE and rest-redis tribution Tl-201 tomography before revascularization and a repeat resting e chocardiogram greater than or equal to 2 months later. RESULTS Global wall motion score index decreased from 2.38 +/- 0.73 to 1.94 +/- 0.82 after revascularization (p < 0.001). Thirty-eight percent of seve rely dysfunctional segments recovered resting function. Compared to segment s without recovery of resting function, those with recovery had greater EDW T (0.94 +/- 0.18 cm vs. 0.67 +/- 0.22 cm, p less than or equal to 0.0001) a nd a higher Tl-201 uptake (78 +/- 13% vs. 59 +/- 21%; p < 0.0001). An EDWV >0.6 cm had a sensitivity of 94% and specificity of 48% for recovery of fun ction. Similarly, a T1-201 maximal uptake of greater than or equal to 60% h ad a sensitivity of 91% and specificity of 50%. Receiver operating characte ristic curves for prediction of recovery of regional and global function we re similar for EDWT and maximum Tl-201 uptake. Combination of EDWT and an!, contractile reserve during DSE for recovery of regional function improved the specificity to 77% without a significant loss in sensitivity (88%). CONCLUSIONS End-diastolic wall thickness is an important marker of myocardi al viability in patients with suspected hibernation, and it can predict rec overy of function similar to T1-201 scintigraphy. Importantly, a simple mea surement or EDWT less than or equal to 0.6 cm virtually excludes the potent ial for recovery of function and is a valuable adjunct to DSE in the assess ment of myocardial viability. (J Am Coll Cardiol 2000;35:1152-61) (C) 2000 by the American College of Cardiology.