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Improved identification of viable myocardium using second harmonic imaging during dobutamine stress echocardiography
  1. F B Sozzia,
  2. D Poldermansa,
  3. J J Baxa,
  4. A Elhendya,
  5. E C Vourvouria,
  6. R Valkemaa,
  7. J De Suttera,
  8. A F L Schinkela,
  9. A Borghettib,
  10. J R T C Roelandta
  1. aThoraxcenter, Erasmus Medical Centre, Dr Molewaterplein 40, 3015 GD Rotterdam, Netherlands, bDepartment of Medicine, Nephrology and Health Science, Parma University, Italy
  1. Dr Poldermanspoldermans{at}


OBJECTIVE To determine whether, compared with fundamental imaging, second harmonic imaging can improve the accuracy of dobutamine stress echocardiography for identifying viable myocardium, using nuclear imaging as a reference.

PATIENTS 30 patients with chronic left ventricular dysfunction (mean (SD) age, 60 (8) years; 22 men).

METHODS Dobutamine stress echocardiography was carried out in all patients using both fundamental and second harmonic imaging. All patients underwent dual isotope simultaneous acquisition single photon emission computed tomography (DISA-SPECT) with99mtechnetium-tetrofosmin/18F-fluorodeoxyglucose on a separate day. Myocardial viability was considered present by dobutamine stress echocardiography when segments with severe dysfunction showed a biphasic sustained improvement or an ischaemic response. Viability criteria on DISA-SPECT were normal or mildly reduced perfusion and metabolism, or perfusion/metabolism mismatch.

RESULTS Using fundamental imaging, 330 segments showed severe dysfunction at baseline; 144 (44%) were considered viable. The agreement between dobutamine stress echocardiography by fundamental imaging and DISA-SPECT was 78%, κ = 0.56. Using second harmonic imaging, 288 segments showed severe dysfunction; 138 (48%) were viable. The agreement between dobutamine stress echocardiography and DISA-SPECT was significantly better when second harmonic imaging was used (89%, κ = 0.77, p = 0.001v fundamental imaging).

CONCLUSIONS Second harmonic imaging applied during dobutamine stress echocardiography increases the agreement with DISA-SPECT for detecting myocardial viability.

  • dobutamine stress echocardiography
  • second harmonic imaging
  • 18F-fluorodeoxyglucose imaging
  • myocardial viability

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