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      Prediction of Left Ventricular Functional Recovery by Dobutamine Echocardiography, F-18 Deoxyglucose or 99mTc Sestamibi Nuclear Imaging in Patients with Chronic Myocardial Infarction

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          Abstract

          Background: Currently, several modalities are available to predict viability, however, studies comparing various modalities validated by functional recovery after revascularization are scarce. This study analyzed the relative merits of low-dose dobutamine echocardiography, F-18 deoxyglucose (FDG) positron emission tomography (PET) and <sup>99m</sup>Tc sestamibi single-photon emission computed tomography to predict functional recovery after revascularization in patients with chronic myocardial infarction. Methods: Patients with chronic coronary occlusion (duration: 3.1 ± 4.8 years) and impaired left ventricular function (ejection fraction: 42 ± 13%) underwent low-dose dobutamine echocardiography (20 µg/kg/min), FDG-PET and <sup>99m</sup>Tc sestamibi imaging before revascularization. Revascularization was performed irrespective of any viability data. Follow-up angiography was obtained 4.8 ± 2.5 months after revascularization. Results: Viability analysis was performed in 34 patients with patent target vessel at follow-up, of whom 9 (27%) exhibited functional recovery on left ventricular angiography. For dobutamine echocardiography, improvement of ≧2 adjacent akinetic segments resulted in improved sensitivity of 89% and specificity of 80% to predict functional recovery. For glucose metabolism, FDG uptake >55% was an optimal threshold yielding a sensitivity of 89% and a specificity of 68%. With respect to perfusion, <sup>99m</sup>Tc sestamibi uptake >60% was the best cutoff resulting in a sensitivity and a specificity of 56 and 88%, respectively. A concordant match of FDG >55% and of <sup>99m</sup>Tc sestamibi >50% resulted in optimized sensitivity (78%) and specificity (80%) with dual imaging. Conclusions: Recovery of chronically dysfunctional myocardium can be predicted with high accuracy by stimulation of contractile reserve or by concordant match of preserved glucose metabolism and residual perfusion.

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          Attenuation-corrected 99mTc-tetrofosmin single-photon emission computed tomography in the detection of viable myocardium: comparison with positron emission tomography using 18F-fluorodeoxyglucose

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            Early dobutamine echocardiography predicts improvement in regional and global left ventricular function after reperfused acute myocardial infarction without residual stenosis of the infarct-related artery

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              Author and article information

              Journal
              CRD
              Cardiology
              10.1159/issn.0008-6312
              Cardiology
              S. Karger AG
              0008-6312
              1421-9751
              2002
              January 2003
              21 January 2003
              : 98
              : 4
              : 202-209
              Affiliations
              aDepartment of Internal Medicine, Division of Cardiology, and bDepartment of Nuclear Medicine, University Hospital Eppendorf, Hamburg, and cDepartment of Nuclear Medicine, Klinikum Rechts der Isar, München, Germany; d Cardiovascular Research and Training Center, University of Washington, Seattle, Wash., USA
              Article
              67311 Cardiology 2002;98:202–209
              10.1159/000067311
              12566650
              © 2003 S. Karger AG, Basel

              Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

              Page count
              Figures: 2, Tables: 4, References: 25, Pages: 8
              Categories
              Noninvasive and Diagnostic Cardiology

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