Document Detail


Comparison of dobutamine echocardiography, dobutamine sestamibi, and rest-redistribution thallium-201 single-photon emission computed tomography for determining contractile reserve and myocardial ischemia in ischemic cardiomyopathy.
MedLine Citation:
PMID:  10498129     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Both dobutamine stress echocardiography (DSE) and myocardial perfusion scintigraphy are used to assess myocardial viability. Few studies have compared the data on myocardial viability and ischemia by low and peak dose DSE and myocardial perfusion imaging in the same patients. Fifty-four patients (45 men and 9 women aged 65 +/- 9 years) with ischemic cardiomyopathy (mean ejection fraction 24 +/- 9%) underwent rest 4-hour redistribution thallium-201 single-photon emission computed tomography (SPECT), low and peak dose DSE, and dobutamine sestamibi SPECT. A total of 864 segments were analyzed (16 segments/patient). Wall motion abnormality was present in 796 segments (92%), and contractile reserve during dobutamine infusion was seen in 400 of these segments (50%). Contractile reserve was seen in 331 of 509 hypokinetic segments (65%) and 69 of 287 akinetic/dyskinetic segments (24%) (p <0.001). Contractile reserve was more frequent in segments with normal thallium uptake (64%), reversible thallium defects (42%), or mild to moderate fixed thallium defects (48%) than severely fixed defects (22%) (p <0.05 each). Concordant information about viability by thallium imaging and DSE was obtained in 62% of segments. Dobutamine sestamibi ischemia was seen in 518 of 796 segments (65%) compared with 265 segments (33%) by DSE (p <0.001). Scintigraphic ischemia was noted in 126 of 195 segments (65%) demonstrating biphasic response, 129 of 205 segments (63%) showing sustained improvement, 42 of 70 segments (60%) deteriorating during dobutamine infusion, and 221 of 326 (68%) demonstrating no change (p = NS). Thus, in patients with ischemic cardiomyopathy, contractile reserve is more frequent in hypokinetic segments than akinetic/dyskinetic segments. The number of segments with normal or near-normal thallium uptake or with scintigraphic ischemia is significantly greater than the number of those capable of increasing contractile function or demonstrating an ischemic response during dobutamine echocardiography.
Authors:
A M Amanullah; F A Chaudhry; J Heo; K Galatro; P Dourdoufis; S Brozena; J Narula; A E Iskandrian
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The American journal of cardiology     Volume:  84     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  1999 Sep 
Date Detail:
Created Date:  1999-10-06     Completed Date:  1999-10-06     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  626-31     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, MCP Hahnemann School of Medicine, Philadelphia, Pennsylvania, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Cardiotonic Agents / diagnostic use*
Cohort Studies
Coronary Circulation / physiology
Dobutamine / diagnostic use*
Echocardiography*
Exercise Test
Female
Heart Transplantation / physiology
Humans
Male
Middle Aged
Myocardial Contraction / physiology*
Myocardial Ischemia / diagnosis*,  physiopathology,  surgery
Myocardial Revascularization
Prospective Studies
Technetium Tc 99m Sestamibi / diagnostic use
Thallium Radioisotopes / diagnostic use*
Tissue Survival / physiology
Tomography, Emission-Computed, Single-Photon*
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 0/Thallium Radioisotopes; 109581-73-9/Technetium Tc 99m Sestamibi; 34368-04-2/Dobutamine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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