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European Heart Journal 2000 21(16):1358-1367; doi:10.1053/euhj.1999.2038
Copyright © 2000 by the European Society of Cardiology.
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Sensitivity, specificity, and predictive accuracies of non-invasive tests, singly and in combination, for diagnosis of hibernating myocardium

G LaCannaa, S.H Rahimtoolab, O Visiolia, R Giubbinic, O Alfierid, M Zogniod, E Milanc, C Ceconia, M Garganoa, R LoRussod and R Ferraria,f1

a Cattedra di Cardiologia, Università degli Studi di Brescia, Brescia, Italy
b Division of Cardiology, Department of Medicine, University of Southern California and Los Angeles County, University of Southern California Medical Center, Los Angeles, California, U.S.A.
c Medicina Nucleare, Spedali Civili, Brescia, Italy
d II Divisione di Cardiochirurgia, Spedali Civili, Brescia, Italy

revised October 13, 1999; accepted December 1, 1999

Abstract

Objective To determine the best test(s) for predicting functional recovery of hibernating myocardium after reperfusion.

Methods A prospective study to compare echocardiographic left ventricular diastolic wall thickness (≥5mm), low-dose dobutamine echocardiography and rest-redistribution thallium-201 scintigraphy, alone and in combination, for predicting recovery of left ventricular akinesis after surgical revascularization.

Results Twenty-eight consecutive patients aged 58±9 years were studied. Of the 448 left ventricular segments, 263 were akinetic at rest; 230/263 (87%) had wall thickness ≥5mm, 135 (51%) had a positive response and 175 (66·5%) were graded viable on thallium. Of akinetic segments 61% improved after surgery. Left ventricular score decreased from 2·3±0·4 to 1·8±0·4 (P<0·01) and ejection fraction increased from 27±10 to 37±14% (P<0·01). For predicting results at 1 year, diastolic wall thickness had a sensitivity and a predictive accuracy of a negative test of 100% but a specificity of 28% and predictive accuracy of a positive test of 61%. The addition of dobutamine echocardiography or thallium-201 improved the predictive accuracy of a positive test to 76% and 69%, respectively; the addition of both tests was not of greater benefit than that of a single test.

Conclusions Diastolic wall thickness <5mm on echocardiography was the best simple and single predictor of non-recovery of left ventricular dysfunction. The addition of dobutamine echocardiography or thallium-201, but not both, was the best solution for predicting recovery of left ventricular dysfunction. In times of limited resources, these findings are important from a clinical point of view.

f1 Correspondence: Professor Roberto Ferrari, Arcispedale S. Anna, Nuove Cliniche–III piano, Corso Giovecca 203, 44100 Ferrara, Italy.

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