Sensitivity, specificity, and predictive accuracies of non-invasive tests,singly and in combination, for diagnosis of hibernating myocardium

Objective To determine the best test(s) for predicting functional recovery of hibernating myocardium after reperfusion. Methods A prospective study to compare echocardiographic left ventricular d iastolic wall thickness (greater than or equal to 5 mm), low-dose dobutamin e echocardiography and rest-redistribution thallium-201 scintigraphy, alone and in combination, for predicting recovery of left ventricular akinesis a fter surgical revascularization. Results Twenty-eight consecutive patients aged 58 +/- 9 years were studied. Of the 448 left ventricular segments, 263 were akinetic at rest: 230/263 ( 87%) had wall thickness greater than or equal to 5 mm, 135 (51%) had a posi tive response and 175 (66.5%) were graded viable on thallium. Of akinetic s egments 61% improved after surgery. Left ventricular score decreased from 2 .3 +/- 0.4 to 1.8 +/- 0.4 (P<0.01) and ejection fraction increased from 27 +/- 10 to 37 +/- 14% (P<0.01). For predicting results at 1 year, diastolic wall thickness had a sensitivity and a predictive accuracy of a negative te st of 100% but a specificity of 28% and predictive accuracy of a positive t est of 61%. The addition of dobutamine echocardiography or thallium-201 imp roved the predictive accuracy of a positive test to 76% and 69%, respective ly; the addition of both tests was not of greater benefit than that of a si ngle test. Conclusions Diastolic wall thickness <5 mm on echocardiography was the best simple and single predictor of non-recovery of left ventricular dysfunctio n. The addition of dobutamine echocardiography or thallium-201, but not bot h, was the best solution for predicting recovery of left ventricular dysfun ction. In times of limited resources, these findings are important from a c linical point of view. (C) 2000 The European Society of Cardiology.