Accuracy of currently available techniques for prediction of functional recovery after revascularization in patients with left ventricular dysfunction due to chronic coronary artery disease: comparison of pooled data

Department of Cardiology, Academic Hospital, Leiden, The Netherlands. bax@cardio.azl.nl

OBJECTIVES: This study evaluated the relative merits of the most frequently used techniques for predicting improvement in regional contractile function after coronary revascularization in patients with left ventricular dysfunction due to chronic coronary artery disease. BACKGROUND: Several techniques have been proposed for predicting improvement in regional contractile function after revascularization, including thallium-201 (Tl-201) stress-redistribution-reinjection, Tl-201 rest-redistribution, fluorine-18 fluorodeoxyglucose with positron emission tomography, technetium-99m sestamibi imaging and low dose dobutamine echocardiography (LDDE). METHODS: A systematic review of all reports on prediction of functional recovery after revascularization in patients with chronic coronary artery disease (published between 1980 and March 1997) revealed 37 with sufficient details for calculating the sensitivity and specificity of each imaging modality. From the pooled data, 95% and 99% confidence intervals were also calculated. RESULTS: Sensitivity for predicting regional functional recovery after revascularization was high for all techniques. The specificity of both Tl-201 protocols was significantly lower (p < 0.05) and LDDE significantly higher (p < 0.01) than that of the other techniques. CONCLUSIONS: Pooled analysis of 37 studies showed that although all techniques accurately identify segments with improved contractile function after revascularization, the Tl-201 protocols may overestimate functional recovery. The evidence available thus far indicates that LDDE appears to have the highest predictive accuracy.

This article has been cited by other articles:

				G. J. Zoghbi, T. A. Dorfman, and A. E. Iskandrian The Effects of Medications on Myocardial Perfusion J. Am. Coll. Cardiol., August 5, 2008; 52(6): 401 - 416. [Abstract] [Full Text] [PDF]

				S. H. Rahimtoola, V. Dilsizian, C. M. Kramer, T. H. Marwick, and J.-L. J. Vanoverschelde Chronic Ischemic Left Ventricular Dysfunction: From Pathophysiology to Imaging and its Integration Into Clinical Practice J. Am. Coll. Cardiol. Img., July 1, 2008; 1(4): 536 - 555. [Abstract] [Full Text] [PDF]

				R. Sicari, P. Nihoyannopoulos, A. Evangelista, J. Kasprzak, P. Lancellotti, D. Poldermans, J.-U. Voigt, J. L. Zamorano, and on behalf of the European Association of Echocardi Stress echocardiography expert consensus statement: European Association of Echocardiography (EAE) (a registered branch of the ESC) Eur J Echocardiogr, July 1, 2008; 9(4): 415 - 437. [Abstract] [Full Text] [PDF]

				M. L. Brown, T. M. Sundt III, and B. J. Gersh Indications for Revascularization Card. Surg. Adult, January 1, 2008; 3(2008): 551 - 572. [Full Text]

				E. J. Velazquez, K. L. Lee, C. M. O'Connor, J. K. Oh, R. O. Bonow, G. M. Pohost, A. M. Feldman, D. B. Mark, J. A. Panza, G. Sopko, et al. The rationale and design of the Surgical Treatment for Ischemic Heart Failure (STICH) trial. J. Thorac. Cardiovasc. Surg., December 1, 2007; 134(6): 1540 - 1547.e4. [Abstract] [Full Text] [PDF]

				P. Lim, C. Bars, L. Mitchell-Heggs, C. Roiron, N. Elbaz, B. Hamdaoui, N. Lellouche, J.-L. Dubois-Rande, and P. Gueret Importance of contractile reserve for CRT Europace, September 1, 2007; 9(9): 739 - 743. [Abstract] [Full Text] [PDF]

				J. C. Wu, F. M. Bengel, and S. S. Gambhir Cardiovascular Molecular Imaging Radiology, August 1, 2007; 244(2): 337 - 355. [Abstract] [Full Text] [PDF]

				M. Penicka, P. Tousek, B. De Bruyne, W. Wijns, O. Lang, J. Madaric, M. Vanderheyden, J. Tintera, M. Maly, P. Widimsky, et al. Myocardial positive pre-ejection velocity accurately detects presence of viable myocardium, predicts recovery of left ventricular function and bears a prognostic value after surgical revascularization Eur. Heart J., June 1, 2007; 28(11): 1366 - 1373. [Abstract] [Full Text] [PDF]

				M. D. Banas, S. Baldwa, G. Suzuki, J. M. Canty Jr., and J. A. Fallavollita Determinants of contractile reserve in viable, chronically dysfunctional myocardium Am J Physiol Heart Circ Physiol, June 1, 2007; 292(6): H2791 - H2797. [Abstract] [Full Text] [PDF]

				A H Gershlick, M de Belder, J Chambers, D Hackett, R Keal, A Kelion, S Neubauer, D J Pennell, M Rothman, M Signy, et al. Role of non-invasive imaging in the management of coronary artery disease: an assessment of likely change over the next 10 years. A report from the British Cardiovascular Society Working Group Heart, April 1, 2007; 93(4): 423 - 431. [Abstract] [Full Text] [PDF]

				L. Hanekom, C. Jenkins, L. Jeffries, C. Case, J. Mundy, C. Hawley, and T. H. Marwick Incremental Value of Strain Rate Analysis as an Adjunct to Wall-Motion Scoring for Assessment of Myocardial Viability by Dobutamine Echocardiography: A Follow-Up Study After Revascularization Circulation, December 20, 2005; 112(25): 3892 - 3900. [Abstract] [Full Text] [PDF]

				V. S. Iyer and J. M. Canty Jr Regional Desensitization of {beta}-Adrenergic Receptor Signaling in Swine With Chronic Hibernating Myocardium Circ. Res., October 14, 2005; 97(8): 789 - 795. [Abstract] [Full Text] [PDF]

				M. Zimarino, A. M. Calafiore, and R. De Caterina Complete myocardial revascularization: between myth and reality Eur. Heart J., September 2, 2005; 26(18): 1824 - 1830. [Abstract] [Full Text] [PDF]

				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 Heart, May 1, 2005; 91(5): 613 - 617. [Abstract] [Full Text] [PDF]

				R Senior, M Monaghan, H Becher, J Mayet, and P Nihoyannopoulos Stress echocardiography for the diagnosis and risk stratification of patients with suspected or known coronary artery disease: a critical appraisal. Supported by the British Society of Echocardiography Heart, April 1, 2005; 91(4): 427 - 436. [Abstract] [Full Text] [PDF]

				V Rizzello, D Poldermans, E Biagini, A F L Schinkel, R van Domburg, A Elhendy, E C Vourvouri, M Bountioukos, A Lombardo, B Krenning, et al. Improvement of stress LVEF rather than rest LVEF after coronary revascularisation in patients with ischaemic cardiomyopathy and viable myocardium Heart, March 1, 2005; 91(3): 319 - 323. [Abstract] [Full Text] [PDF]

				T M Bateman and E Prvulovich Assessment of prognosis in chronic coronary artery disease Heart, August 1, 2004; 90(suppl_5): v10 - v15. [Full Text] [PDF]

				S. B. Labib, M. Goldstein, P. M. Kinnunen, and E. C. Schick Cardiac events in patients with negative maximal versus negative submaximal dobutamine echocardiograms undergoing noncardiac surgery: Importance of resting wall motion abnormalities J. Am. Coll. Cardiol., July 7, 2004; 44(1): 82 - 87. [Abstract] [Full Text] [PDF]

				H. S. Maniar, B. P. Cupps, D. D. Potter, P. Moustakidis, C. J. Camillo, C. M. Chu, M. K. Pasque, and T. M. Sundt III Ventricular function after coronary artery bypass grafting: Evaluation by magnetic resonance imaging and myocardial strain analysis J. Thorac. Cardiovasc. Surg., July 1, 2004; 128(1): 76 - 82. [Abstract] [Full Text] [PDF]

				S.R. Underwood, J. J Bax, J. v. Dahl, M. Y Henein, A. C van Rossum, E. R Schwarz, J.-L. Vanoverschelde, E. E.v. d. Wall, and W. Wijns Imaging techniques for the assessment of myocardial hibernation: Report of a Study Group of the European Society of Cardiology Eur. Heart J., May 2, 2004; 25(10): 815 - 836. [Abstract] [Full Text] [PDF]

				V. Go, M. R. Bhatt, and R. C. Hendel The Diagnostic and Prognostic Value of ECG-Gated SPECT Myocardial Perfusion Imaging J. Nucl. Med., May 1, 2004; 45(5): 912 - 921. [Abstract] [Full Text] [PDF]

				M Bountioukos, A F L Schinkel, J J Bax, V Rizzello, R Valkema, B J Krenning, E Biagini, E C Vourvouri, J R T C Roelandt, and D Poldermans Pulsed wave tissue Doppler imaging for the quantification of contractile reserve in stunned, hibernating, and scarred myocardium Heart, May 1, 2004; 90(5): 506 - 510. [Abstract] [Full Text] [PDF]

				C. Nelson, J. McCrohon, F. Khafagi, S. Rose, R. Leano, and T. H. Marwick Impact of scar thickness on the assessment of viability using dobutamine echocardiography and thallium single-photon emission computed tomography: A comparison with contrast-enhanced magnetic resonance imaging J. Am. Coll. Cardiol., April 7, 2004; 43(7): 1248 - 1256. [Abstract] [Full Text] [PDF]

				K. Shan, G. Constantine, M. Sivananthan, and S. D. Flamm Role of Cardiac Magnetic Resonance Imaging in the Assessment of Myocardial Viability Circulation, March 23, 2004; 109(11): 1328 - 1334. [Full Text] [PDF]

				M. Pitt, D. Dutka, D. Pagano, P. Camici, and R. Bonser The natural history of myocardium awaiting revascularisation in patients with impaired left ventricular function Eur. Heart J., March 2, 2004; 25(6): 500 - 507. [Abstract] [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 Why do patients with ischemic cardiomyopathy and a substantial amount of viable myocardium not always recover in function after revascularization? J. Thorac. Cardiovasc. Surg., February 1, 2004; 127(2): 385 - 390. [Abstract] [Full Text] [PDF]

				C. Vahlhaus, H.-J. Bruns, J. Stypmann, T. D.T Tjan, F. Janssen, M. Schafers, H. H Scheld, O. Schober, G. Breithardt, and T. Wichter Direct epicardial mapping predicts the recovery of left ventricular dysfunction in chronic ischaemic myocardium Eur. Heart J., January 2, 2004; 25(2): 151 - 157. [Abstract] [Full Text] [PDF]

				K. C. Wu and J. A.C. Lima Noninvasive Imaging of Myocardial Viability: Current Techniques and Future Developments Circ. Res., December 12, 2003; 93(12): 1146 - 1158. [Abstract] [Full Text] [PDF]

				B. P. Griffith Surgical treatment of congestive heart failure: evolving options Ann. Thorac. Surg., December 1, 2003; 76(6): S2254 - 2259. [Full Text] [PDF]

				A. E. B. van der Burg, J. J. Bax, E. Boersma, E. K.J. Pauwels, E. E. van der Wall, and M. J. Schalij Impact of Viability, Ischemia, Scar Tissue, and Revascularization on Outcome After Aborted Sudden Death Circulation, October 21, 2003; 108(16): 1954 - 1959. [Abstract] [Full Text] [PDF]

				Committee Members, F. J. Klocke, M. G. Baird, B. H. Lorell, T. M. Bateman, J. V. Messer, D. S. Berman, P. T. O'Gara, B. A. Carabello, R. O. Russell Jr, et al. ACC/AHA/ASNC Guidelines for the Clinical Use of Cardiac Radionuclide Imaging--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging) J. Am. Coll. Cardiol., October 1, 2003; 42(7): 1318 - 1333. [Full Text] [PDF]

				F. J. Klocke, M. G. Baird, B. H. Lorell, T. M. Bateman, J. V. Messer, D. S. Berman, P. T. O'Gara, B. A. Carabello, R. O. Russell Jr, M. D. Cerqueira, et al. ACC/AHA/ASNC Guidelines for the Clinical Use of Cardiac Radionuclide Imaging--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging) Circulation, September 16, 2003; 108(11): 1404 - 1418. [Full Text] [PDF]

				Z.-X. He, R.-F. Shi, Y.-J. Wu, Y.-Q. Tian, X.-J. Liu, S.-W. Wang, R. Shen, X.-W. Qin, R.-L. Gao, J. Narula, et al. Direct Imaging of Exercise-Induced Myocardial Ischemia With Fluorine-18-Labeled Deoxyglucose and Tc-99m-Sestamibi in Coronary Artery Disease Circulation, September 9, 2003; 108(10): 1208 - 1213. [Abstract] [Full Text] [PDF]

				R. Sciagra Nitrates and Viability: A Durable Affair J. Nucl. Med., May 1, 2003; 44(5): 752 - 755. [Full Text] [PDF]

				S. E. Langerak, H. W. Vliegen, J. W. Jukema, P. Kunz, A. H. Zwinderman, H. J. Lamb, E. E. van der Wall, and A. de Roos Value of Magnetic Resonance Imaging for the Noninvasive Detection of Stenosis in Coronary Artery Bypass Grafts and Recipient Coronary Arteries Circulation, March 25, 2003; 107(11): 1502 - 1508. [Abstract] [Full Text] [PDF]

				H. Wiggers, H. E. Botker, P. Sogaard, A. Kaltoft, F. Hermansen, W. Y. Kim, L. Krusell, and L. Thuesen Electromechanical mapping versus positron emission tomography and single photon emission computed tomography for the detection of myocardial viability in patients with ischemic cardiomyopathy J. Am. Coll. Cardiol., March 5, 2003; 41(5): 843 - 848. [Abstract] [Full Text] [PDF]

				F. C. Visser Prediction of Surgical Treatment Effect by Preoperative Imaging:Present and Future Perspectives Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2003; 7(1): 31 - 36. [PDF]

				A. F.L. Schinkel, J. J. Bax, R. van Domburg, A. Elhendy, R. Valkema, E. C. Vourvouri, F. B. Sozzi, J. R.T.C. Roelandt, and D. Poldermans Dobutamine-Induced Contractile Reserve in Stunned, Hibernating, and Scarred Myocardium in Patients with Ischemic Cardiomyopathy J. Nucl. Med., February 1, 2003; 44(2): 127 - 133. [Abstract] [Full Text] [PDF]

				T. M. Sundt III, B. J. Gersh, and H. C. Smith Indications for Coronary Revascularization Card. Surg. Adult, January 1, 2003; 2(2003): 541 - 559. [Full Text]

				K. Kitagawa, H. Sakuma, T. Hirano, S. Okamoto, K. Makino, and K. Takeda Acute Myocardial Infarction: Myocardial Viability Assessment in Patients Early Thereafter--Comparison of Contrast-enhanced MR Imaging with Resting 201Tl SPECT Radiology, January 1, 2003; 226(1): 138 - 144. [Abstract] [Full Text] [PDF]

				B. J Malm, G. Suzuki, J. M Canty Jr., and J. A Fallavollita Variability of contractile reserve in hibernating myocardium: dependence on the method of inotropic stimulation Cardiovasc Res, December 1, 2002; 56(3): 422 - 432. [Abstract] [Full Text] [PDF]

				A. Keck, K. Hertting, Y. Schwartz, R. Kitzing, M. Weber, B. Leisner, C. Franke, E. Bahlmann, C. Schneider, T. Twisselmann, et al. Electromechanical mapping for determination of myocardial contractility and viability: A comparison with echocardiography, myocardial single-photon emission computed tomography, and positron emission tomography J. Am. Coll. Cardiol., September 18, 2002; 40(6): 1067 - 1074. [Abstract] [Full Text] [PDF]

				F. W. Dupont, R. M. Lang, M. L. Drum, and S. Aronson Is There a Long-Term Predictive Value of Intraoperative Low-Dose Dobutamine Echocardiography in Patients Who Have Coronary Artery Bypass Graft Surgery with Cardiopulmonary Bypass? Anesth. Analg., September 1, 2002; 95(3): 517 - 523. [Abstract] [Full Text] [PDF]

				A F L Schinkel, J J Bax, F B Sozzi, E Boersma, R Valkema, A Elhendy, J R T C Roelandt, and D Poldermans Prevalence of myocardial viability assessed by single photon emission computed tomography in patients with chronic ischaemic left ventricular dysfunction Heart, August 1, 2002; 88(2): 125 - 130. [Abstract] [Full Text] [PDF]

				J. A. Fallavollita, M. Logue, and J. M. Canty Jr. Coronary patency and its relation to contractile reserve in hibernating myocardium Cardiovasc Res, July 1, 2002; 55(1): 131 - 140. [Abstract] [Full Text] [PDF]

				I. Matsunari, J. Taki, and N. Tonami Sequential Strategy Using Multimodality Viability Tests: Does It Work? J. Nucl. Med., June 1, 2002; 43(6): 803 - 805. [Full Text] [PDF]

				P. B. Jacklin, S. F. Barrington, J. C. Roxburgh, G. Jackson, D. Sariklis, P. A. West, and M. N. Maisey Cost-effectiveness of preoperative positron emission tomography in ischemic heart disease Ann. Thorac. Surg., May 1, 2002; 73(5): 1403 - 1409. [Abstract] [Full Text] [PDF]

				K. C. Allman, L. J. Shaw, R. Hachamovitch, and J. E. Udelson Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis J. Am. Coll. Cardiol., April 3, 2002; 39(7): 1151 - 1158. [Abstract] [Full Text] [PDF]

				R. O. Bonow Myocardial viability and prognosis in patients with ischemic left ventricular dysfunction J. Am. Coll. Cardiol., April 3, 2002; 39(7): 1159 - 1162. [Full Text] [PDF]

				T Zaglavara, R Haaverstad, B Cumberledge, T Irvine, H Karvounis, G Parharidis, G Louridas, and A Kenny Dobutamine stress echocardiography for the detection of myocardial viability in patients with left ventricular dysfunction taking {beta} blockers: accuracy and optimal dose Heart, April 1, 2002; 87(4): 329 - 335. [Abstract] [Full Text] [PDF]

				K. F. Kofoed, R. Bangsgaard, S. Carstensen, J. H. Svendsen, P. R. Hansen, H. Arendrup, B. Hesse, and H. Kelbaek Prolonged ischemic heart disease and coronary artery bypass -- relation to contractile reserve Eur. J. Cardiothorac. Surg., March 1, 2002; 21(3): 417 - 423. [Abstract] [Full Text] [PDF]

				R. Hoffmann, E. Altiok, B. Nowak, N. Heussen, H. Kuhl, H.-J.u. Kaiser, U. Bull, and P. Hanrath Strain rate measurement by doppler echocardiography allows improvedassessment of myocardial viability inpatients with depressed left ventricular function J. Am. Coll. Cardiol., February 6, 2002; 39(3): 443 - 449. [Abstract] [Full Text] [PDF]

				F. Song, K. S Khan, J. Dinnes, and A. J Sutton Asymmetric funnel plots and publication bias in meta-analyses of diagnostic accuracy Int. J. Epidemiol., February 1, 2002; 31(1): 88 - 95. [Abstract] [Full Text] [PDF]

				C. Klein, S. G. Nekolla, F. M. Bengel, M. Momose, A. Sammer, F. Haas, B. Schnackenburg, W. Delius, H. Mudra, D. Wolfram, et al. Assessment of Myocardial Viability With Contrast-Enhanced Magnetic Resonance Imaging: Comparison With Positron Emission Tomography Circulation, January 15, 2002; 105(2): 162 - 167. [Abstract] [Full Text] [PDF]

				Answers to multiple-choice questionnaire: Advances in radionuclide imaging [from Imaging 13(3)] Imaging, December 15, 2001; 13(5): 411 - 415. [Full Text] [PDF]

				C Anagnostopoulos, M Y Henein, and S R Underwood Non-invasive investigations: Ischaemic heart disease Br. Med. Bull., October 1, 2001; 59(1): 29 - 44. [Abstract] [Full Text] [PDF]

				J. J. Bax, F. C. Visser, D. Poldermans, A. Elhendy, J. H. Cornel, E. Boersma, A. van Lingen, P. M. Fioretti, and C. A. Visser Time Course of Functional Recovery of Stunned and Hibernating Segments After Surgical Revascularization Circulation, September 18, 2001; 104(90001): I-314 - 318. [Abstract] [Full Text] [PDF]

				B.L Gerber, F.F Ordoubadi, W Wijns, J.-L.J Vanoverschelde, M.J Knuuti, M Janier, P Melon, P.K Blanksma, A Bol, J.J Bax, et al. Positron emission tomography using18F-fluoro-deoxyglucose and euglycaemic hyperinsulinaemic glucose clamp: optimal criteria for the prediction of recovery of post-ischaemic left ventricular dysfunction. Results from the European Community Concerted Action Multicenter study on use of18F-fluoro-deoxyglucose Positron Emission Tomography for the Detection of Myocardial Viability Eur. Heart J., September 2, 2001; 22(18): 1691 - 1701. [Abstract] [PDF]

				K. Yoshinaga, K. Morita, S. Yamada, K. Komuro, C. Katoh, Y. Ito, Y. Kuge, T. Kohya, A. Kitabatake, and N. Tamaki Low-Dose Dobutamine Electrocardiograph-Gated Myocardial SPECT for Identifying Viable Myocardium: Comparison with Dobutamine Stress Echocardiography and PET J. Nucl. Med., June 1, 2001; 42(6): 838 - 844. [Abstract] [Full Text] [PDF]