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. 1999 Oct;82(4):432–437. doi: 10.1136/hrt.82.4.432

Concordance between dobutamine Doppler tissue imaging echocardiography and rest reinjection thallium-201 tomography in dysfunctional hypoperfused myocardium

F Larrazet 1, D Pellerin 1, D Daou 1, S Witchitz 1, C Fournier 1, A Prigent 1, C Veyrat 1
PMCID: PMC1760277  PMID: 10490555

Abstract

OBJECTIVE—To evaluate the efficiency of the new technique colour Doppler tissue imaging (DTI) by studying the concordance between dobutamine DTI, standard grey scale echocardiography (SE), and rest-reinjection TI-201 tomography (TI) in dysfunctional myocardium.
PATIENTS—23 patients with chronic wall motion abnormalities and proven coronary artery disease (> 70% diameter stenosis of at least one major coronary artery at angiogram).
METHODS—The contractile reserve and the resting perfusion characteristics of dysfunctional myocardial segments were assessed with low dose dobutamine SE and/or DTI (2.5 up to 20 γ/kg/min) and TI on a semiquantitative basis. The DTI or SE data were separately compared with TI, on the basis of a 13 segment ventricular model. The resulting score of combined DTI and SE was also compared with TI. Finally the results obtained from DTI were compared with SE.
RESULTS—A total of 142 severely hypokinetic or akinetic segments were visualised. The viability study was feasible in 127 (89%) and 121 (85%) segments with DTI and SE, respectively. TI detected viability more frequently than DTI (84 v 61, p < 0.001) and SE (80 v 50, p < 0.001). However, as many viable segments were detected with combined DTI and SE as with TI (78 v 84, NS). The κ values between TI and SE, DTI or combined SE and DTI were 0.38, 0.45, and 0.57, respectively, and increased to 0.52 and 0.76, respectively, for SE and DTI versus TI when mid-anterior and mid-inferior segments only were considered. The κ value between SE and DTI was 0.34.
CONCLUSIONS—DTI is a helpful adjunct to SE, when using low dose dobutamine. This combination revealed as many viable segments as TI and showed a better agreement than DTI or SE alone for the assessment of myocardial viable segments evidenced by TI.


Keywords: colour Doppler tissue imaging; hibernating myocardium; thallium 201 single photon emission computed tomography; stress echocardiography

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Figure 1  .

Figure 1  

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Viability assessment of the septoapical and lateroapical regions of the left ventricle in a patient with a severe left anterior descending coronary artery stenosis. Top: at rest, the septolateroapical area is not encoded (arrows) in early (left) and late (right) systole. Bottom: at the same periods of the cardiac cycle, wall encoding appears after low dose dobutamine.

Figure 2  .

Figure 2  

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Ischaemia/viability assessment of the septoapical portion of the left ventricle with thallium-201 tomography in the same patient as fig 1. The images show stress on the left and redistribution on the right with the septoapical defect recovery.

Selected References

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