Doppler tissue velocity sampling improves diagnostic accuracy during dobutamine stress echocardiography for the assessment of viable myocardium in patients with severe left ventricular dysfunction

Background Both nuclear imaging with Fluorodeoxyglucose and dobutamine stre ss echocardiography have been used to identify viable myocardium, although dobutamine-stress echocardiography has been demonstrated to be the less sen sitive of the two. Aim To compare the accuracy of pulsed-wave Doppler tissue sampling with dob utamine-stress echocardiography for the detection of viable myocardium, usi ng F18-fluorodeoxyglucose imaging as a reference. Methods Forty patients with chronic coronary artery disease and left ventri cular dysfunction (mean ejection fraction 33 +/- 11%), underwent F18-fluoro deoxyglucose imaging, dobutamine-stress echocardiography and pulsed-wave Do ppler tissue sampling. Evaluation was performed using a six-segment model. Results Visual assessment by resting echo was feasible in 230 out of 240 se gments (96%); 177 (77%) segments showed severe dyssynergy at rest. F18-fluo rodeoxyglucose imaging showed viability in 95 (54%) segments while 82 (46%) were non-viable. Ejection phase velocity at rest was not significantly dif ferent; ejection velocities during low-dose and peak-dose dobutamine, howev er, were significantly higher in viable myocardium (8.6 +/- 2.9 vs 6.0 +/- 1.8 and 9.3 +/- 3 1 vs 6.2 +/- 2.1 cm.s(-1)). Using receiver operating char acteristic curves the optimal cut-off value for viability assessment was an increase in the ejection phase velocity low-dose of 1 +/- 0.5 cm.s(-1), wh ile 0 +/- 0.5 cm.s(-1) predicted non-viability. The sensitivity and specifi city (95%CI) of pulsed-wave Doppler tissue sampling and dobutamine-stress e chocardiography for the prediction of viability was respectively 87% (82-92 ) vs 75% (67-81) (P < 0.05) and 52% (44-59) vs 51% (45-59) (P = ns). Conclusions The sensitivity of pulsed-wave Doppler tissue sampling is super ior to dobutamine-stress echocardiography for the assessment of myocardial viability. (C) 2000 The European Society of Cardiology.