Comparison of simultaneous dobutamine echocardiography and thallium-201 stress-reinjection single-photon emission computed tomography in predicting improvement of chronic myocardial dysfunction after revascularization

Previous studies have shown that ultrasonic integrated backscatter is valua ble in characterizing stunned myocardium. Recent investigations have demons trated that resting cardiac cycle-dependent variation of integrated backsca tter closely paralleled the contractile reserve In patients with chronic le ft ventricular ischemic dysfunction, The purpose of this study was to valid ate whether ultrasonic tissue characterization (UTC) compared with dobutami ne stress echocardiography (DSE) and thallium-201 stress-reinjection single -photon emission computed tomography (Tl-SPECT) could predict reversible my ocardial dyssynergy in patients with chronic coronary artery disease. Forty -eight patients with stable coronary artery disease underwent UTC, DSE, and Tl-SPECT simultaneously before successful coronary revascularization and w ere followed up with echocardiagrams at rest >3 months later. Among the 58 investigated segments, the weighted amplitude, a composite parameter derive d from the integrated backscatter power curve, was larger for those groups with greater functional recovery (p <0.001), For the persistent akinetic se gments, the weighted amplitudes were small with large deviations of the nad ir ratios that represented the asynchrony between the intramural contractil e events and the global systole, Using the cut-off valve 2.0 of the weighte d amplitude, the sensitivity and specificity for predicting functional impr ovement after revascularization were both 82.8% (kappa = 0.66) and comparab le to the sensitivity and specificity of DSE and Tl-SPECT. UTC, delineating the myocardial physical state and intramural contraction, can be a novel a pproach in predicting functional improvement of chronic dyssynergy after re vascularization, (C) 2000 by Excerpta Medica, Inc.