Comparison of dobutamine echocardiography and positron emission tomography in patients with chronic ischemic left ventricular dysfunction

Department of Cardiology, Austin and Repatriation Medical Center, Melbourne, Australia.

OBJECTIVES: The aim of this study was to correlate dobutamine-induced contractile reserve as detected by echocardiography with findings on positron emission tomography in patients with chronic ischemic left ventricular dysfunction. BACKGROUND: Contractile reserve induced by low dose dobutamine infusion has been proposed as a marker of myocardial viability. METHODS: Sixty patients with stable coronary artery disease and left ventricular dysfunction (mean ejection fraction [+/- SD] 29 +/- 10%) underwent transthoracic echocardiography with dobutamine infusion (up to 10 micrograms/kg body weight per min) and positron emission tomography with nitrogen-13 ammonia and fluorine-18 (F-18) fluorodeoxyglucose as a perfusion and a metabolic tracer, respectively. Regional wall motion, perfusion and metabolism were analyzed semiquantitatively by using a 16-segment model. Segments with F-18 fluorodeoxyglucose uptake > 50% were considered viable on positron emission tomography. RESULTS: After dobutamine infusion, hemodynamic variables changed significantly, and myocardial ischemia was evident in 17 patients. All 60 patients had dysfunctional myocardium considered viable on positron emission tomography (8 +/- 4 segments/patient), whereas 52 patients had dysfunctional myocardium with contractile enhancement by dobutamine echocardiography (4 +/- 2 segments/patient, p = 0.01). The extent of dysfunctional myocardium with contractile reserve appeared to correlate less closely with the total extent of viable dysfunctional myocardium identified by positron emission tomography than with the number of such segments associated with a pattern of perfusion-metabolism mismatch. CONCLUSIONS: In patients with chronic ischemic left ventricular dysfunction, echocardiography can be used to identify enhancement in the contractile function of viable dysfunctional myocardium after infusion of low dose dobutamine. In this study, the presence and extent of such enhancement were relatively less than the values obtained from positron emission tomography.

This article has been cited by other articles:

				M Egred, A Al-Mohammad, G D Waiter, T W Redpath, S K Semple, M Norton, A Welch, and S Walton Detection of scarred and viable myocardium using a new magnetic resonance imaging technique: blood oxygen level dependent (BOLD) MRI Heart, July 1, 2003; 89(7): 738 - 744. [Abstract] [Full Text] [PDF]

				G. I.W. Galasko and A. Lahiri The non-invasive assessment of hibernating myocardium in ischaemic cardiomyopathy--a myriad of techniques Eur J Heart Fail, June 1, 2003; 5(3): 217 - 227. [Abstract] [Full Text] [PDF]

				K Shimada, Y Sakanoue, Y Kobayashi, S Ehara, M Hirose, Y Nakamura, D Fukuda, H Yamagishi, M Yoshiyama, K Takeuchi, et al. Assessment of myocardial viability using coronary zero flow pressure after successful angioplasty in patients with acute anterior myocardial infarction Heart, January 1, 2003; 89(1): 71 - 76. [Abstract] [Full Text] [PDF]

				D Pagano, J N Townend, D V Parums, R S Bonser, and P G Camici Hibernating myocardium: morphological correlates of inotropic stimulation and glucose uptake Heart, April 1, 2000; 83(4): 456 - 461. [Abstract] [Full Text]

				A. Pasquet, M.S. Lauer, M.J. Williams, M.-A. Secknus, B. Lytle, and T.H. Marwick Prediction of global left ventricular function after bypass surgery in patients with severe left ventricular dysfunction. Impact of pre-operative myocardial function, perfusion, and metabolism Eur. Heart J., January 2, 2000; 21(2): 125 - 136. [Abstract] [PDF]

				A Al-Mohammad, M Y Norton, I R Mahy, J C Patel, A E Welch, P Mikecz, and S Walton Can the surface electrocardiogram be used to predict myocardial viability? Heart, December 1, 1999; 82(6): 663 - 667. [Abstract] [Full Text]

				A Al-Mohammad, I R Mahy, M Y Norton, G Hillis, J C Patel, P Mikecz, and S Walton Prevalence of hibernating myocardium in patients with severely impaired ischaemic left ventricles Heart, December 1, 1998; 80(6): 559 - 564. [Abstract] [Full Text]

				G. D. Trachiotis, W. S. Weintraub, T. S. Johnston, E. L. Jones, R. A. Guyton, and J. M. Craver Coronary artery bypass grafting in patients with advanced left ventricular dysfunction Ann. Thorac. Surg., November 1, 1998; 66(5): 1632 - 1639. [Abstract] [Full Text] [PDF]

				I. Matsunari, G. Boning, S. I. Ziegler, S. G. Nekolla, J. C. Stollfuss, I. Kosa, E. P. Ficaro, and M. Schwaiger Attenuation-corrected 99mTc-tetrofosmin single-photon emission computed tomography in the detection of viable myocardium: comparison with positron emission tomography using 18F-fluorodeoxyglucose J. Am. Coll. Cardiol., October 1, 1998; 32(4): 927 - 935. [Abstract] [Full Text] [PDF]

				G. E. Cimochowski, M. D. Harostock, and P. J. Foldes MINIMAL OPERATIVE MORTALITY IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS WITH SIGNIFICANT LEFT VENTRICULAR DYSFUNCTION BY MAXIMIZATION OF METABOLIC AND MECHANICAL SUPPORT J. Thorac. Cardiovasc. Surg., April 1, 1997; 113(4): 655 - 666. [Abstract] [Full Text]

				S. H. Rahimtoola Hibernating Myocardium Has Reduced Blood Flow at Rest That Increases With Low-Dose Dobutamine Circulation, December 15, 1996; 94(12): 3055 - 3061. [Full Text]