Dobutamine echocardiography and quantitative rest-redistribution 201Tl tomography in myocardial hibernation: Relation of contractile reserve to 201Tl uptake and comparative prediction of recovery of function

Usman Qureshi, Sherif Nagueh, Imran Afridi, Periyanan Vaduganathan, Alvin Blaustein, Mario S. Verani, William L. Winters, Jr., William A. Zoghbi

Research output: Contribution to journalArticle

156 Scopus citations

Abstract

Background: The purposes of this study were to evaluate the comparative accuracy of dobutamine echocardiography and quantitative rest-redistribution 201Tl tomography in the prediction of recovery of function after revascularization and to assess the relation of contractile reserve to thallium uptake. Methods and Results: Thirty-four patients with stable coronary disease and regional dysfunction underwent dobutamine echocardiography (2.5 up to 40 μg · kg-1 · min-1) and rest redistribution 201Tl tomography 1 day before revascularization. Resting echocardiography and scintigraphy were repeated at ≤6 weeks. Before revascularization, resting 201Tl uptake was similar in segment demonstrating biphasic or sustained improvement and was higher than in those exhibiting no change or worsening function during dobutamine. After revascularization, 201Tl uptake increased only in segments that showed a biphasic response (from 66±12% to 78±13%; P<.05). Biphasic response had a sensitivity of 74% and specificity of 89% for prediction of recovery. The use of biphasic or sustained improvement responses increased the sensitivity to 86% with a decrease in specificity to 68%. Qualitative thallium assessment provided a high sensitivity (98%) but poor specificity (27%). Quantification of thallium uptake, however, improved its accuracy; a maximal uptake (at rest or redistribution) of ≤60% yielded a 90% sensitivity and a 56% specificity. Conclusions: In patients with myocardial hibernation, biphasic response during dobutamine is less sensitive but more specific for recovery of function, whereas indexes of 201Tl scintigraphy are in general more sensitive and less specific, the least accurate being a qualitative assessment of thallium uptake. The sensitivity and specificity of both methods, however, can be altered depending on the quantitative criteria of thallium uptake or combination of responses of the myocardium to dobutamine.

Original languageEnglish (US)
Pages (from-to)626-635
Number of pages10
JournalCirculation
Volume95
Issue number3
DOIs
StatePublished - Jan 1 1997

Keywords

  • coronary disease
  • echocardiography
  • revascularization
  • stunning, myocardial
  • tomography

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Dobutamine echocardiography and quantitative rest-redistribution <sup>201</sup>Tl tomography in myocardial hibernation: Relation of contractile reserve to <sup>201</sup>Tl uptake and comparative prediction of recovery of function'. Together they form a unique fingerprint.

Cite this