Combined dipyridamole and dobutamine echocardiography in myocardial hibernation: Comparison with thallium uptake in patients after percutaneous transluminal coronary revascularization under circulatory support

Objective: To investigate the specificity and sensitivity of the combinatio n of dipyridamole and dobutamine echocardiography for predicting functional recovery in patients with reduced ventricular function after coronary angi oplasty. Methods. Twenty-five patients, mean (SD) age 60.8 (10) years, with previous myocardial infarction (> 3 months), angiographically assessed coronary art ery disease, and resting regional dysfunction (left ventricular ejection fr action < 35%) were studied. They underwent rest-redistribution thallium Tl- 201 single photon emission computed tomography, and low-dose pharmacologic stress echocardiography with dobutamine (up to 10 mug/kg per minute), ultra low-dose dipyridamole (0.28 mg/kg over 4 minutes), and combined dipyridamo le-dobutamine administration. Results. The rate of agreement between Tl-201 and stress echo was 59% for d ipyridamole, 62% for dobutamine, and 71% for combined dipyridamole-dobutami ne (P < .05 vs dipyridamole and vs dobutamine). Combined dipyridamole-dobut amine showed a higher sensitivity (89%) than Tl-201, dobutamine, or dipyrid amole (84%, 78%, and 80%). Specificity was lower for functional recovery pr ediction with Tl-201 (60%) compared with dobutamine (89%), dipyridamole (90 %), and combined dipyridamole-dobutamine (91%). Conclusion: Thallium is more sensitive than dipyridamole or dobutamine; the sensitivity gap is filled with combined dipyridamole-dobutamine. Pharmacol ogic stress echocardiography is more specific than Tl-201 scintigraphy.