Dobutamine echocardiography predicts functional outcome after revascularisation in patients with dysfunctional myocardium irrespective of the perfusion pattern on resting thallium-201 imaging

Abstract

OBJECTIVE To evaluate whether the predictive value of dobutamine echocardiography for assessing contractile reserve was altered by differing patterns of regional myocardial perfusion.

PATIENTS 31 consecutive patients with symptomatic congestive heart failure (left ventricular ejection fraction < 35%) caused by coronary artery disease.

SETTING A district general hospital.

METHODS Thallium-201 perfusion imaging and low dose dobutamine (5–15 μg/kg/min) echocardiography were performed and resting echocardiography was repeated three months after revascularisation. Perfusion pattern and systolic wall thickening were compared using a 12 segment left ventricular model.

RESULTS Of the 273 severely dysfunctional segments, 106 (39%) showed a normal perfusion and 167 (61%) an abnormal pattern. After revascularisation, recovery occurred in 71 of the segments with a normal perfusion pattern, and in these a dobutamine response was observed in 61 (86%); recovery also occurred in 56 segments with a mild to moderate abnormality of perfusion, and in these a dobutamine response was seen in 46 (81%) (NS). After revascularisation, the positive and negative predictive values for recovery of dysfunctional segments, where the majority were abnormally perfused, were 88% and 86%, respectively. Systolic wall thickening score indices improved from (mean (SD)) 3.21 (0.58) to 2.6 (0.66) (p < 0.001) after revascularisation in dobutamine responsive patients (n = 24) compared with patients who did not show a dobutamine response (2.86 (0.65) and 3.13 (0.56), p = 0.61, respectively).

CONCLUSIONS Dobutamine echocardiography predicted improvement of dysfunctional myocardium after revascularisation irrespective of the resting perfusion pattern seen.