Determining myocardial viability in chronic ischemic left ventricular dysfunction

A prospective comparison of rest-redistribution thallium 201 single-photon emission computed tomography, nitroglycerin-dobutamine echocardiography, and intracoronary myocardial contrast echocardiography

Lieng H. Ling, Timothy F. Christian, Sharon L. Mulvagh, Kyle W. Klarich, Mary F. Hauser, Rick A. Nishimura, Patricia Pellikka

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: Detection of viable myocardium (VM) has important therapeutic implications for chronic ischemic left ventricular (LV) systolic dysfunction. We compared the ability of nitroglycerin-dobutamine echocardiography (NTG-DE), intracoronary myocardial contrast echocardiography (MCE), and rest-redistribution thallium 201 single-photon emission computed tomography (RRT-SPECT) to detect VM in this setting. Methods: Patients with LV ejection fraction (LVEF) <40% and multivessel coronary disease suitable for revascularization underwent NTG-DE, MCE, RRT-SPECT, and radionuclide ventriculography to determine baseline LVEF. Myocardial contrast echocardiography was performed using intracoronary injection of Albunex. Patients who underwent revascularization had 3-month postprocedural radionuclide ventriculography and transthoracic echocardiography to assess functional recovery. Results: Of 512 myocardial segments in the 32 patients studied, 309 were akinetic or dyskinetic at baseline. Nitroglycerin alone increased regional thickening in 20% of segments with contractile reserve. By RRT-SPECT, 93% of nitroglycerin-responsive segments were viable. Myocardial contrast echocardiography had up to 85% sensitivity and 74% specificity for detection of VM diagnosed by RRT-SPECT. In the 23 patients who underwent revascularization, 54% of akinetic segments showed improved contractility, and mean LVEF increased from 32% to 37% (P = .04). Sensitivities and specificities for detecting functional recovery were 95% and 37% for RRT-SPECT, up to 87% and 48% for MCE, and 63% and 83% for a biphasic response during NTG-DE. Conclusions: In patients with chronic ischemic LV dysfunction, RRT-SPECT had the highest sensitivity, and NTG-DE, the best specificity for detection of VM. Nitroglycerin facilitated detection of VM and may be a useful adjunct to dobutamine stimulation.

Original languageEnglish (US)
Pages (from-to)882-889
Number of pages8
JournalAmerican Heart Journal
Volume151
Issue number4
DOIs
StatePublished - Apr 2006

Fingerprint

Dobutamine
Thallium
Nitroglycerin
Left Ventricular Dysfunction
Single-Photon Emission-Computed Tomography
Echocardiography
Myocardium
Radionuclide Ventriculography
Sensitivity and Specificity
Stroke Volume
Coronary Disease
Injections

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{7aa8cb6bd32947feb3c234d03ed35a15,
title = "Determining myocardial viability in chronic ischemic left ventricular dysfunction: A prospective comparison of rest-redistribution thallium 201 single-photon emission computed tomography, nitroglycerin-dobutamine echocardiography, and intracoronary myocardial contrast echocardiography",
abstract = "Background: Detection of viable myocardium (VM) has important therapeutic implications for chronic ischemic left ventricular (LV) systolic dysfunction. We compared the ability of nitroglycerin-dobutamine echocardiography (NTG-DE), intracoronary myocardial contrast echocardiography (MCE), and rest-redistribution thallium 201 single-photon emission computed tomography (RRT-SPECT) to detect VM in this setting. Methods: Patients with LV ejection fraction (LVEF) <40{\%} and multivessel coronary disease suitable for revascularization underwent NTG-DE, MCE, RRT-SPECT, and radionuclide ventriculography to determine baseline LVEF. Myocardial contrast echocardiography was performed using intracoronary injection of Albunex. Patients who underwent revascularization had 3-month postprocedural radionuclide ventriculography and transthoracic echocardiography to assess functional recovery. Results: Of 512 myocardial segments in the 32 patients studied, 309 were akinetic or dyskinetic at baseline. Nitroglycerin alone increased regional thickening in 20{\%} of segments with contractile reserve. By RRT-SPECT, 93{\%} of nitroglycerin-responsive segments were viable. Myocardial contrast echocardiography had up to 85{\%} sensitivity and 74{\%} specificity for detection of VM diagnosed by RRT-SPECT. In the 23 patients who underwent revascularization, 54{\%} of akinetic segments showed improved contractility, and mean LVEF increased from 32{\%} to 37{\%} (P = .04). Sensitivities and specificities for detecting functional recovery were 95{\%} and 37{\%} for RRT-SPECT, up to 87{\%} and 48{\%} for MCE, and 63{\%} and 83{\%} for a biphasic response during NTG-DE. Conclusions: In patients with chronic ischemic LV dysfunction, RRT-SPECT had the highest sensitivity, and NTG-DE, the best specificity for detection of VM. Nitroglycerin facilitated detection of VM and may be a useful adjunct to dobutamine stimulation.",
author = "Ling, {Lieng H.} and Christian, {Timothy F.} and Mulvagh, {Sharon L.} and Klarich, {Kyle W.} and Hauser, {Mary F.} and Nishimura, {Rick A.} and Patricia Pellikka",
year = "2006",
month = "4",
doi = "10.1016/j.ahj.2005.06.023",
language = "English (US)",
volume = "151",
pages = "882--889",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - Determining myocardial viability in chronic ischemic left ventricular dysfunction

T2 - A prospective comparison of rest-redistribution thallium 201 single-photon emission computed tomography, nitroglycerin-dobutamine echocardiography, and intracoronary myocardial contrast echocardiography

AU - Ling, Lieng H.

AU - Christian, Timothy F.

AU - Mulvagh, Sharon L.

AU - Klarich, Kyle W.

AU - Hauser, Mary F.

AU - Nishimura, Rick A.

AU - Pellikka, Patricia

PY - 2006/4

Y1 - 2006/4

N2 - Background: Detection of viable myocardium (VM) has important therapeutic implications for chronic ischemic left ventricular (LV) systolic dysfunction. We compared the ability of nitroglycerin-dobutamine echocardiography (NTG-DE), intracoronary myocardial contrast echocardiography (MCE), and rest-redistribution thallium 201 single-photon emission computed tomography (RRT-SPECT) to detect VM in this setting. Methods: Patients with LV ejection fraction (LVEF) <40% and multivessel coronary disease suitable for revascularization underwent NTG-DE, MCE, RRT-SPECT, and radionuclide ventriculography to determine baseline LVEF. Myocardial contrast echocardiography was performed using intracoronary injection of Albunex. Patients who underwent revascularization had 3-month postprocedural radionuclide ventriculography and transthoracic echocardiography to assess functional recovery. Results: Of 512 myocardial segments in the 32 patients studied, 309 were akinetic or dyskinetic at baseline. Nitroglycerin alone increased regional thickening in 20% of segments with contractile reserve. By RRT-SPECT, 93% of nitroglycerin-responsive segments were viable. Myocardial contrast echocardiography had up to 85% sensitivity and 74% specificity for detection of VM diagnosed by RRT-SPECT. In the 23 patients who underwent revascularization, 54% of akinetic segments showed improved contractility, and mean LVEF increased from 32% to 37% (P = .04). Sensitivities and specificities for detecting functional recovery were 95% and 37% for RRT-SPECT, up to 87% and 48% for MCE, and 63% and 83% for a biphasic response during NTG-DE. Conclusions: In patients with chronic ischemic LV dysfunction, RRT-SPECT had the highest sensitivity, and NTG-DE, the best specificity for detection of VM. Nitroglycerin facilitated detection of VM and may be a useful adjunct to dobutamine stimulation.

AB - Background: Detection of viable myocardium (VM) has important therapeutic implications for chronic ischemic left ventricular (LV) systolic dysfunction. We compared the ability of nitroglycerin-dobutamine echocardiography (NTG-DE), intracoronary myocardial contrast echocardiography (MCE), and rest-redistribution thallium 201 single-photon emission computed tomography (RRT-SPECT) to detect VM in this setting. Methods: Patients with LV ejection fraction (LVEF) <40% and multivessel coronary disease suitable for revascularization underwent NTG-DE, MCE, RRT-SPECT, and radionuclide ventriculography to determine baseline LVEF. Myocardial contrast echocardiography was performed using intracoronary injection of Albunex. Patients who underwent revascularization had 3-month postprocedural radionuclide ventriculography and transthoracic echocardiography to assess functional recovery. Results: Of 512 myocardial segments in the 32 patients studied, 309 were akinetic or dyskinetic at baseline. Nitroglycerin alone increased regional thickening in 20% of segments with contractile reserve. By RRT-SPECT, 93% of nitroglycerin-responsive segments were viable. Myocardial contrast echocardiography had up to 85% sensitivity and 74% specificity for detection of VM diagnosed by RRT-SPECT. In the 23 patients who underwent revascularization, 54% of akinetic segments showed improved contractility, and mean LVEF increased from 32% to 37% (P = .04). Sensitivities and specificities for detecting functional recovery were 95% and 37% for RRT-SPECT, up to 87% and 48% for MCE, and 63% and 83% for a biphasic response during NTG-DE. Conclusions: In patients with chronic ischemic LV dysfunction, RRT-SPECT had the highest sensitivity, and NTG-DE, the best specificity for detection of VM. Nitroglycerin facilitated detection of VM and may be a useful adjunct to dobutamine stimulation.

UR - http://www.scopus.com/inward/record.url?scp=33645241269&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33645241269&partnerID=8YFLogxK

U2 - 10.1016/j.ahj.2005.06.023

DO - 10.1016/j.ahj.2005.06.023

M3 - Article

VL - 151

SP - 882

EP - 889

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

IS - 4

ER -