Accuracy of dobutamine echocardiography for detection of myocardial viability in patients with an occluded left anterior descending coronary artery

Department of Medicine, University of Texas Southwestern and Veterans Affairs Medical Centers, Dallas, USA.

OBJECTIVES: We studied the accuracy of dobutamine echocardiography for the detection of myocardial viability in patients with an occluded left anterior descending coronary artery and regional ventricular dysfunction. BACKGROUND: Contractile reserve during dobutamine echocardiography is an accurate marker of myocardial viability in patients with coronary stenoses and ventricular dysfunction. However, its accuracy in patients with an occluded vessel has not been evaluated. METHODS: We studied 41 patients with > 50% stenosis of the left anterior descending coronary artery and regional ventricular dysfunction who underwent dobutamine echocardiography for detection of viable myocardium. Contractile reserve was defined as improvement in wall motion score of two or more contiguous septal or anterior segments during doubutamine echocardiography. Recovery of function was defined as improvement in rest wall motion score of two or more contiguous segments after revascularization. RESULTS: Patients were classified into two groups according to the presence (n = 20) or absence (n = 21) of left anterior descending coronary artery occlusion. Contractile reserve was detected in 40% of patients with an occluded and 43% with a nonoccluded artery (p = 0.8). Of 41 patients, 27 underwent revascularization, 12 with and 15 without an occluded vessel. Recovery of function occurred in 6 (50%) of 12 patients in the occluded artery group and in 5 (33%) of 15 in the nonoccluded artery group (p = 0.4). Among patients with an occluded artery, the positive and negative predictive values of dobutamine echocardiography for recovery of function were 100% (95% confidence interval [CI] 48% to 100%) and 86% (95% CI 42% to 100%), respectively. CONCLUSIONS: Our results indicate that contractile reserve during dobutamine echocardiography can be detected in patients with an occluded vessel and may be useful for predicting recovery of function after revascularization.

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