Copyright © 2000 by the European Society of Cardiology.
Sensitivity, specificity, and predictive accuracies of non-invasive tests, singly and in combination, for diagnosis of hibernating myocardium
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.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  S. H. Rahimtoola, V. Dilsizian, C. M. Kramer, T. H. Marwick, and J.-L. J. Vanoverschelde Chronic Ischemic Left Ventricular Dysfunction: From Pathophysiology to Imaging and its Integration Into Clinical Practice J. Am. Coll. Cardiol. Img., July 1, 2008; 1(4): 536 - 555. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Soliman Hamad, M. E. S.H. Tan, A. H.M. van Straten, A. A.J. van Zundert, and J. P.A.M. Schonberger Long-Term Results of Coronary Artery Bypass Grafting in Patients With Left Ventricular Dysfunction Ann. Thorac. Surg., February 1, 2008; 85(2): 488 - 493. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Kumbasar, O. Akyurek, I. Dincer, Y. Atmaca, M. Kilickap, C. Erol, and D. Oral Good Collaterals Predict Viable Myocardium Angiology, November 1, 2007; 58(5): 550 - 555. [Abstract] [PDF]
|
|
|
|
 |
|
 S. H. Rahimtoola, G. La Canna, and R. Ferrari Hibernating Myocardium: Another Piece of the Puzzle Falls Into Place J. Am. Coll. Cardiol., March 7, 2006; 47(5): 978 - 980. [Full Text] [PDF]
|
|
|
|
 |
|
 T Zaglavara, T Pillay, H Karvounis, R Haaverstad, G Parharidis, G Louridas, and A Kenny Detection of myocardial viability by dobutamine stress echocardiography: incremental value of diastolic wall thickness measurement Heart, May 1, 2005; 91(5): 613 - 617. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Vahlhaus, H.-J. Bruns, J. Stypmann, T. D.T Tjan, F. Janssen, M. Schafers, H. H Scheld, O. Schober, G. Breithardt, and T. Wichter Direct epicardial mapping predicts the recovery of left ventricular dysfunction in chronic ischaemic myocardium Eur. Heart J., January 2, 2004; 25(2): 151 - 157. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Tadamura, M. Mamede, S. Kubo, H. Toyoda, M. Yamamuro, H. Iida, N. Tamaki, K. Nishimura, M. Komeda, and J. Konishi The Effect of Nitroglycerin on Myocardial Blood Flow in Various Segments Characterized by Rest-Redistribution Thallium SPECT J. Nucl. Med., May 1, 2003; 44(5): 745 - 751. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Ceconi, G. La Canna, O. Alfieri, A. Cargnoni, G. Coletti, S. Curello, M. Zogno, G. Parrinello, S. H. Rahimtoola, and R. Ferrari Revascularization of hibernating myocardium. Rate of metabolic and functional recovery and occurrence of oxidative stress Eur. Heart J., December 1, 2002; 23(23): 1877 - 1885. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Lorusso, G. La Canna, C. Ceconi, V. Borghetti, P. Totaro, G. Parrinello, G. Coletti, and G. Minzioni Long-term results of coronary artery bypass grafting procedure in the presence of left ventricular dysfunction and hibernating myocardium Eur. J. Cardiothorac. Surg., November 1, 2001; 20(5): 937 - 948. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C Anagnostopoulos, M Y Henein, and S R Underwood Non-invasive investigations: Ischaemic heart disease Br. Med. Bull., October 1, 2001; 59(1): 29 - 44. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Ferrari Favouring myocardial viability to necrosis: a challenge in ischaemic heart disease with prognostic complications Eur. Heart J., May 2, 2001; 22(10): 803 - 804. [PDF]
|
|
|
|
|
|
F. Bukachi, M.Y. Henein, and S.R. Underwood Predicting the outcome of revascularization in ischaemic left ventricular dysfunction Eur. Heart J., August 2, 2000; 21(16): 1290 - 1292. [PDF]
|
|