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CLINICAL STUDIES

Assessment of myocardial viability by dobutamine echocardiography, positron emission tomography and thallium-201 SPECT

Correlation with histopathology in explanted hearts

Helmut Baumgartner, MD, FACC^a, Gerold Porenta, MD^a, Yuk-Kong Lau, MD^a, Michael Wutte, MD^a, Ursula Klaar, MD^a, Mohammad Mehrabi, MD^a, Robert J. Siegel, MD, FACC^*, Johannes Czernin, MD, G.ünther Laufer, MD^a, Heinz Sochor, MD^a, Heinrich Schelbert, MD, FACC, Michael C. Fishbein, MD, FACC^** and Gerald Maurer, MD, FACC^a

^a Department of Cardiology, Vienna General Hospital, University of Vienna, and the Ludwig Bolzmann Institute for Cardiovascular Research, Vienna, Austria
^* Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
^** Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California, USA
Department of Nuclear Medicine, UCLA Medical Center, University of California at Los Angeles, Los Angeles, California, USA

Manuscript received December 31, 1997; revised manuscript received July 1, 1998, accepted July 24, 1998.

Address for correspondence: Dr. Helmut Baumgartner, Department of Cardiology, Vienna General Hospital, University of Vienna, Währinger Gürtel 18–20, A-1090, Wien, Austria

Objectives. We examined the relationship among viability assessment by dobutamine echocardiography (DE), positron emission tomography (PET) and thallium-201 single-photon emission computed tomography (Tl-SPECT) to the degree of fibrosis.

Background. DE, PET and Tl-SPECT have been shown to be sensitive in identifying viability of asynergic myocardium. However, PET and Tl-SPECT indicated viability in a significant percentage of segments without dobutamine response or functional improvement after revascularization.

Methods. Twelve patients with coronary artery disease and severely reduced left ventricular function (EF 14.5 ± 5.2%) were studied with DE prior to cardiac transplantation: 5 had additional PET and 7 had Tl-SPECT studies. Results of the three techniques were compared to histologic findings of the explanted hearts.

Results. Segments with >75% viable myocytes by histology were determined to be viable in 78%, 89% and 87% by DE, PET and Tl-SPECT; those with 50–75% viable myocytes in 71%, 50% and 87%, respectively. Segments with 25–50% viable myocytes showed response to dobutamine in only 15%, but were viable in 60% by PET and 82% by Tl-SPECT. Segments with <25% viable myocytes responded to dobutamine in 19%; however, PET and Tl-SPECT demonstrated viability in 33% and 38%, respectively. Discrepant segments without dobutamine response but viability by PET and SPECT had significantly more viable myocytes by pathology than did those classified in agreement to be nonviable but had significantly less viable myocytes than those classified in agreement to be viable (p < .001).

Conclusions. These findings suggest that contractile reserve as evidenced by a positive dobutamine response requires at least 50% viable myocytes in a given segment whereas scintigraphic methods also identify segments with less viable myocytes. Thus, the methods may provide complementary information: Nuclear techniques appear to be highly sensitive for the detection of myocardial viability, and negative tests make it highly unlikely that a significant number of viable myocytes are present in a given segment. Conversely, dobutamine echo may be particularly useful for predicting recovery of systolic function after revascularization.

Abbreviations and Acronyms   DE = dobutamine echocardiography   EF = ejection fraction   PET = positron emission tomography   Tl-SPECT = thallium-201 single-photon emission computed tomography

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