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. 1998 Mar;79(3):281–288. doi: 10.1136/hrt.79.3.281

Predictive value of dobutamine echocardiography and positron emission tomography in identifying hibernating myocardium in patients with postischaemic heart failure

D Pagano 1, R Bonser 1, J Townend 1, F Ordoubadi 1, R Lorenzoni 1, P Camici 1
PMCID: PMC1728621  PMID: 9602663

Abstract

Objective—To compare the predictive value of dobutamine echocardiography (DE) and positron emission tomography (PET) in identifying reversible chronic left ventricular (LV) dysfunction (hibernating myocardium) in patients with coronary artery disease (CAD) and overt heart failure.
Patients—30 patients (four women) with CAD and heart failure undergoing coronary artery bypass grafting (CABG).
Methods—Myocardial viability was assessed with DE (5 and 10 µg/kg/min) and PET with [18F] 2-fluoro-2-deoxy-D-glucose (FDG) under hyperinsulinaemic euglycaemic clamp. Regional (echo) and global LV function (MUGA) were assessed at baseline and six months after CABG.
Results—192 of the 336 (57%) dysfunctional LV segments improved function following CABG (hibernating) and the LV ejection fraction (EF) increased from 23(7) to 32(9)% (p < 0.0001) (in 17 patients > 5%). DE and PET had similar positive predictive values (68% and 66%) in the identification of hibernating myocardium, but DE had a significantly lower negative predictive value than PET (54% v 96%; p < 0.0001). A significant linear correlation was found between the number of PET viable segments and the changes in EF following CABG (r = 0.65; p = 0.0001). Stepwise logistic regression identified the number of PET viable segments as an independent predictor of improvement in EF > 5%, whereas the number of DE viable segments, the baseline LVEF, and wall motion were not.
Conclusions—DE has a higher false negative rate than PET in identifying recoverable LV dysfunction in patients with severe postischaemic heart failure. The amount of PET viable myocardium correlates with the functional outcome following CABG.

 Keywords: dobutamine echocardiography;  positron emission tomography;  coronary artery disease;  heart failure;  hibernating myocardium

Full Text

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Figure 1  .

Figure 1  

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(A) Positive and (B) negative predictive values of PET and DE in hypokinetic (Hypo) and akinetic (Aki) left ventricular segments. Note in particular that the negative predictive value of DE decreases in the more dysfunctional segments.

Figure 2  .

Figure 2  

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Linear relation between the number of PET viable left ventricular segments and the changes in left ventricular ejection fraction (δ-EF) following coronary revascularisation.

Figure 3  .

Figure 3  

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Linear relation between the number of dobutamine viable (DE) left ventricular segments and the changes in left ventricular ejection fraction (δ-EF) following coronary revascularisation.

Figure 4  .

Figure 4  

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Comparison of overall sensitivity, specificity, and accuracy of PET and DE.

Figure 5  .

Figure 5  

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ROC curves demonstrating the sensitivity-specificity pairs for the number of PET viable (solid line) and DE viable (broken line) segments required to obtain improvements in LVEF > 5% points following CABG. The arrows indicate the operator point for each test associated with the best trade-off between sensitivity and specificity. This was eight for PET (sensitivity 0.88, specificity 0.75) and seven for DE (sensitivity 0.47, specificity 0.91). Note the better performance of PET (area under the curve 0.75) compared with DE (area under the curve 0.69).

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