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J Am Coll Cardiol, 2000; 35:1152-1161
© 2000 by the American College of Cardiology Foundation
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ARTICLE

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

Jucylea M. Cwajg, MDa,1, Eduardo Cwajg, MDa, Sherif F. Nagueh, MD, FACCa, Zuo-Xiang He, MDa, Usman Qureshi, MD, FACCa, Leopoldo I. Olmos, MDa, Miguel A. Quinones, MD, FACCa, Mario S. Verani, MD, FACCa, William L. Winters, MD, MACCa and William A. Zoghbi, MD, FACCa

a Section of Cardiology, Baylor College of Medicine and the Methodist Hospital Echocardiography and Nuclear Cardiology Laboratories, Houston, Texas, USA

Manuscript received April 16, 1999; revised manuscript received October 27, 1999, accepted December 15, 1999.

Reprint requests and correspondence: Dr. William A. Zoghbi, Director, Echocardiography Research, Baylor College of Medicine, 6550 Fannin, SM-677, Houston, Texas 77030
wzoghbi{at}bcm.tmc.edu

OBJECTIVES

The study assessed whether end-diastolic wall thickness (EDWT), measured with echocardiography, is an important marker of myocardial viability in patients with suspected myocardial hibernation, and it compared this index to currently established diagnostic modalities of dobutamine stress echocardiography (DSE) and rest-redistribution thallium-201 (Tl-201) scintigraphy.

BACKGROUND

Because myocardial necrosis is associated with myocardial thinning, preserved EDWT may provide a simple index of myocardial viability that is readily available from the resting echocardiogram.

METHODS

Accordingly, 45 patients with stable coronary artery disease and ventricular dysfunction underwent rest 2D echocardiograms, DSE and rest-redistribution Tl-201 tomography before revascularization and a repeat resting echocardiogram ≥2 months later.

RESULTS

Global wall motion score index decreased from 2.38 ± 0.73 to 1.94 ± 0.82 after revascularization (p < 0.001). Thirty-eight percent of severely dysfunctional segments recovered resting function. Compared to segments without recovery of resting function, those with recovery had greater EDWT (0.94 ± 0.18 cm vs. 0.67 ± 0.22 cm, p ≤ 0.0001) and a higher Tl-201 uptake (78 ± 13% vs. 59 ± 21%; p < 0.0001). An EDWT >0.6 cm had a sensitivity of 94% and specificity of 48% for recovery of function. Similarly, a Tl-201 maximal uptake of ≥60% had a sensitivity of 91% and specificity of 50%. Receiver operating characteristic curves for prediction of recovery of regional and global function were similar for EDWT and maximum Tl-201 uptake. Combination of EDWT and any contractile reserve during DSE for recovery of regional function improved the specificity to 77% without a significant loss in sensitivity (88%).

CONCLUSIONS

End-diastolic wall thickness is an important marker of myocardial viability in patients with suspected hibernation, and it can predict recovery of function similar to Tl-201 scintigraphy. Importantly, a simple measurement of EDWT ≤0.6 cm virtually excludes the potential for recovery of function and is a valuable adjunct to DSE in the assessment of myocardial viability.

Abbreviations and Acronyms
  AUC = area under the curve
  CAD = coronary artery disease
  DSE = dobutamine stress echocardiography
  EDWT = end-diastolic wall thickness
  SPECT = single-photon emission computed tomography
  T1-201 = thallium-201
  WMSI = wall motion score index




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