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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

View larger version (19K): [in a new window]   Figure 1 Viable and nonviable segments as assessed by dobutamine echocardiography (DE), PET and Tl imaging (SPECT) for the four histologically classified groups. The total number of segments available for each method and the number of segments for each histological group are indicated. Black sectors represent the percentage of segments classified to be nonviable.

View larger version (11K): [in a new window]   Figure 2 Comparison of dobutamine echocardiography (ECHO) with PET and Tl imaging (SPECT). Black sectors indicate the percentage of segments with disagreement between echocardiography and nuclear method.

View larger version (10K): [in a new window]   Figure 3 Pathology score (mean ± SEM) for combined results of echocardiography and nuclear studies. Pathology score 0 = <25% viable myocytes, 1 = 25–50%; 2 = 50–75%; 3 = >75% viable myocytes. DE–/Tl– = both dobutamine echo and Tl-SPECT judged nonviable; DE–/Tl+ = no dobutamine response but viability by Tl-SPECT; DE+/Tl+ = both dobutamine and Tl-SPECT judged viable; DE–/PET– = both dobutamine echo and PET judged nonviable; DE–/PET+ = no dobutamine response but viability by PET; DE+/PET+ = both dobutamine and PET judged viable.