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
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Figure 1 Parasternal long axis (left upper panel), short axis at the base and midventricle (middle and right upper panels) and apical views (lower panels) showing location of measurements of end-diastolic wall thickness (EDWT) in the various myocardial segments (see text) in a patient with ischemic cardiomyopathy evaluated for myocardial viability. The inferior septum (at the base and midventricle) was not measured separately for the purposes of matching segments with Tl-201 scintigraphy. Parasternal windows usually provided a better resolution of basal and midventricular segments, whereas the apical windows allowed measurements of apical segments, in addition to others. As can be seen, EDWT of the apex was the most difficult to measure (see text) and was not recorded in this patient.
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Figure 2 Relation of rest wall motion to end-diastolic wall thickness (EDWT) and rest-redistribution thallium-201 uptake. NL = normal; Hypk = hypokinesia; Ak = akinesia; Dysk = dyskinesia.
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Figure 3 Scatter plot of individual measurements of end-diastolic wall thickness and maximum Tl-201 uptake in segments with and without recovery of systolic function after revascularization.
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Figure 4 Receiver operating characteristic curves for prediction of recovery of function after revascularization with end-diastolic wall thickness (EDWT) and rest-redistribution Tl-201 uptake before revascularization.
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Figure 5 End-diastolic wall thickness at baseline grouped according to maximum Tl-201 uptake and contractile reserve during dobutamine echocardiography prior to revascularization.
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Figure 6 Diagram of the outcome of severely dysfunctional myocardial segments after revascularization grouped by end-diastolic wall thickness (EDWT) and contractile reserve to dobutamine. Rec = recovery of function.
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Figure 7 Sensitivity (black bars) and specificity (shaded bars) for recovery of function after revascularization using end-diastolic wall thickness (EDWT), rest-redistribution thallium uptake, and dobutamine stress echocardiography (DSE) responses.
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