Identification of hibernating myocardium: comparative accuracy of myocardial contrast echocardiography, rest-redistribution thallium-201 tomography and dobutamine echocardiography
SF Nagueh,
P Vaduganathan,
N Ali,
A Blaustein,
MS Verani,
WL Winters Jr,
and
WA Zoghbi
Department of Medicine, Baylor College of Medicine, The Methodist Hospital, Houston, Texas 77030, USA.
OBJECTIVES: We sought to evaluate the comparative accuracy of myocardial contrast echocardiography (MCE), quantitative rest-redistribution thallium-201 (Tl-201) tomography and low and high dose (up to 40 microg/kg body weight per min) dobutamine echocardiography (DE) in identifying myocardial hibernation. BACKGROUND: Myocardial contrast echocardiography can assess myocardial perfusion and may therefore be useful in predicting myocardial hibernation. However, its accuracy in comparison to myocardial perfusion scintigraphy and to that of high dose DE remains to be investigated. METHODS: Eighteen patients (aged [+/- SD] 57 +/- 10 years) with stable coronary artery disease and ventricular dysfunction underwent the above three modalities before coronary revascularization. Myocardial contrast echocardiography was achieved with intracoronary Albunex. Rest echocardiographic and Tl-201 studies were repeated > or = 6 weeks after revascularization. RESULTS: Of 109 revascularized segments with severe dysfunction, 46 (42%) improved. Left ventricular ejection fraction increased from 38 +/- 14% to 45 +/- 13% at follow-up (p = 0.003). Rest Tl-201 uptake and the ratio of peak contrast intensity of dysfunctional to normal segments with MCE were higher (p < 0.01) in segments that recovered function compared with those that did not. Myocardial contrast echocardiography, thallium scintigraphy and any contractile reserve during DE had a similar sensitivity (89% to 91%) with a lower specificity (43% to 66%) for recovery of function. A biphasic response during DE was the most specific (83%) and the least sensitive (68%) (p < 0.01). The best concordance with MCE was Tl-201 (80%, kappa 0.57). Changes in ejection fraction after revascularization related significantly to the number of viable dysfunctional segments by all modalities (r = 0.54 to 0.65). CONCLUSIONS: In myocardial hibernation, methods evaluating rest perfusion (MCE, Tl-201) or any contractile reserve have a similar high sensitivity but a low specificity for predicting recovery of function. A limited contractile reserve (biphasic response) increases the specificity of DE. Importantly, the three techniques identified all patients who had significant improvement in global ventricular function.
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136(4):
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|
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|
|
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July 1, 2007;
48(7):
1135 - 1146.
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[PDF]
|
|
|
|
|
|
|
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June 1, 2007;
8(3):
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|
|
|
|
|
|
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J. Gorcsan III
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Circulation,
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112(25):
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|
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|
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|
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L. Hanekom, C. Jenkins, L. Jeffries, C. Case, J. Mundy, C. Hawley, and T. H. Marwick
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December 20, 2005;
112(25):
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|
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|
|
|
|
|
T Zaglavara, T Pillay, H Karvounis, R Haaverstad, G Parharidis, G Louridas, and A Kenny
Detection of myocardial viability by dobutamine stress echocardiography: incremental value of diastolic wall thickness measurement
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91(5):
613 - 617.
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[Full Text]
[PDF]
|
|
|
|
|
|
|
A. F. L. Schinkel, D. Poldermans, V. Rizzello, J.-L. J. Vanoverschelde, A. Elhendy, E. Boersma, J. R.T.C. Roelandt, and J. J. Bax
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February 1, 2004;
127(2):
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|
|
|
|
|
|
|
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ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article: a report of the American college of cardiology/American heart association task force on practice guidelines (ACC/AHA/ASE committee to update the 1997 guidelines for the clinical application of echocardiography)
J. Am. Coll. Cardiol.,
September 3, 2003;
42(5):
954 - 970.
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[PDF]
|
|
|
|
|
|
|
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September 2, 2003;
108(9):
1146 - 1162.
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|
|
|
|
|
|
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Noninvasive evaluation of ischaemic heart disease: myocardial perfusion imaging or stress echocardiography?
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May 1, 2003;
24(9):
789 - 800.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Shimoni, N. G. Frangogiannis, C. J. Aggeli, K. Shan, M. S. Verani, M. A. Quinones, R. Espada, G. V. Letsou, G. M. Lawrie, W. L. Winters, et al.
Identification of Hibernating Myocardium With Quantitative Intravenous Myocardial Contrast Echocardiography: Comparison With Dobutamine Echocardiography and Thallium-201 Scintigraphy
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February 4, 2003;
107(4):
538 - 544.
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[PDF]
|
|
|
|
|
|
|
S. Shimoni, N. G. Frangogiannis, C. J. Aggeli, K. Shan, M. A. Quinones, R. Espada, G. V. Letsou, G. M. Lawrie, W. L. Winters, M. J. Reardon, et al.
Microvascular Structural Correlates of Myocardial Contrast Echocardiography in Patients With Coronary Artery Disease and Left Ventricular Dysfunction: Implications for the Assessment of Myocardial Hibernation
Circulation,
August 20, 2002;
106(8):
950 - 956.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. J. Bax, J. Maddahi, D. Poldermans, A. Elhendy, J. H. Cornel, E. Boersma, J. R.T.C. Roelandt, and P. M. Fioretti
Sequential 201Tl Imaging and Dobutamine Echocardiography to Enhance Accuracy of Predicting Improved Left Ventricular Ejection Fraction After Revascularization
J. Nucl. Med.,
June 1, 2002;
43(6):
795 - 802.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. A. Swinburn, A. Lahiri, and R. Senior
Intravenous myocardial contrast echocardiography predicts recovery of dysynergic myocardium early after acute myocardial infarction
J. Am. Coll. Cardiol.,
July 1, 2001;
38(1):
19 - 25.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G LaCanna, S.H Rahimtoola, O Visioli, R Giubbini, O Alfieri, M Zognio, E Milan, C Ceconi, M Gargano, R LoRusso, et al.
Sensitivity, specificity, and predictive accuracies of non-invasive tests, singly and in combination, for diagnosis of hibernating myocardium
Eur. Heart J.,
August 2, 2000;
21(16):
1358 - 1367.
[Abstract]
[PDF]
|
|
|
|
|
|
|
J. M. Cwajg, E. Cwajg, S. F. Nagueh, Z.-X. He, U. Qureshi, L. I. Olmos, M. A. Quinones, M. S. Verani, W. L. Winters, and W. A. Zoghbi
End-diastolic wall thickness as a predictor of recovery of function in myocardial hibernation: Relation to rest-redistribution Tl-201 tomography and dobutamine stress echocardiography
J. Am. Coll. Cardiol.,
April 1, 2000;
35(5):
1152 - 1161.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F Larrazet, D Pellerin, D Daou, S Witchitz, C Fournier, A Prigent, and C Veyrat
Concordance between dobutamine Doppler tissue imaging echocardiography and rest reinjection thallium-201 tomography in dysfunctional hypoperfused myocardium
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October 1, 1999;
82(4):
432 - 437.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. F. Nagueh, I. Mikati, D. Weilbaecher, M. J. Reardon, G. J. Al-Zaghrini, D. Cacela, Z.-X. He, G. Letsou, G. Noon, J. F. Howell, et al.
Relation of the Contractile Reserve of Hibernating Myocardium to Myocardial Structure in Humans
Circulation,
August 3, 1999;
100(5):
490 - 496.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. J. Bax, D. Poldermans, A. Elhendy, J. H. Cornel, E. Boersma, R. Rambaldi, J. R. T. C. Roelandt, and P. M. Fioretti
Improvement of left ventricular ejection fraction, heart failure symptoms and prognosis after revascularization in patients with chronic coronary artery disease and viable myocardium detected by dobutamine stress echocardiography
J. Am. Coll. Cardiol.,
July 1, 1999;
34(1):
163 - 169.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. C. Smart, P. N. Dionisopoulos, T. A. Knickelbine, T. Schuchard, and K. B. Sagar
Dobutamine-atropine stress echocardiography for risk stratification in patients with chronic left ventricular dysfunction
J. Am. Coll. Cardiol.,
February 1, 1999;
33(2):
512 - 521.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. D. Kasprzak, W. B. Vletter, J. R.T.C. Roelandt, J. R. van Meegen, R. Johnson, and F. J. Ten Cate
Visualization and quantification of myocardial mass at risk using three-dimensional contrast echocardiography
Cardiovasc Res,
November 1, 1998;
40(2):
314 - 321.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Meluzin, J. Cerny, M. Frelich, F. Stetka, L. Spinarova, J. Popelova, R. Stipal, and on behalf of the Investigators of This Multicenter
Prognostic value of the amount of dysfunctional but viable myocardium in revascularized patients with coronary artery disease and left ventricular dysfunction
J. Am. Coll. Cardiol.,
October 1, 1998;
32(4):
912 - 920.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Afridi, P. A. Grayburn, J. A. Panza, J. K. Oh, W. A. Zoghbi, and T. H. Marwick
Myocardial viability during dobutamine echocardiography predicts survival in patients with coronary artery disease and severe left ventricular systolic dysfunction
J. Am. Coll. Cardiol.,
October 1, 1998;
32(4):
921 - 926.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
