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Biomedical subjects

E Boersma

Publications and source records attributed to E Boersma.

At least 127 records · Page 7Linked to original sources
PubMed1995

Immediate and late outcome of excimer laser and balloon coronary angioplasty: a quantitative angiographic comparison based on matched lesions.

OBJECTIVES: This study sought to compare acute lumen changes and late lumen narrowing during and after excimer laser-assisted balloon angioplasty, measured by quantitative coronary angiography, with the immediate and long-term outcome of balloon angioplasty alone. BACKGROUND: Although excimer laser coronary angioplasty is used as an adjunct or alternative to balloon angioplasty, limited comparative data exist regarding the immediate and long-term efficacy of excimer laser-assisted balloon angioplasty versus balloon angioplasty alone. METHODS: A series of 53 lesions in 47 consecutive patients successfully treated with excimer laser-assisted balloon angioplasty were individually matched after completion of 6-month follow-up angiography with 53 successfully treated balloon angioplasty lesions according to vessel location, preprocedural minimal lumen diameter and reference diameter. Immediate and long-term angiographic results were assessed by an automated lumen contour detection algorithm. RESULTS: Before intervention in the laser and balloon angioplasty groups, respectively, minimal lumen diameter (mean +/- SD) was 0.73 +/- 0.47 and 0.74 +/- 0.46 mm, and reference diameter was 2.71 +/- 0.42 and 2.72 +/- 0.41 mm. Laser angioplasty was followed by adjunctive balloon dilation in 50 lesions. Mean balloon diameter at maximal inflation was similar in both treatment groups (2.61 +/- 0.32 and 2.65 +/- 0.38 mm, respectively), resulting in similar minimal lumen diameters after intervention of 1.77 +/- 0.41 and 1.78 +/- 0.34 mm, respectively. At follow-up angiography, minimal lumen diameter after excimer laser-assisted balloon angioplasty was 1.17 +/- 0.63 mm, and that after balloon angioplasty alone was 1.46 +/- 0.67 mm (p = 0.02). The angiographic restenosis rates at follow-up using the 50% diameter stenosis cutoff criterion were 57% and 34%, respectively (p = 0.02). CONCLUSIONS: Quantitative angiographic analysis of a matched group of 106 successfully treated coronary lesions showed a similar immediate outcome but reduced long-term efficacy of excimer laser-assisted balloon angioplasty compared with that after balloon angioplasty alone.

Algorithms↗
PubMed1995

Optimal pharmacological stress testing for the diagnosis of coronary artery disease: a probabilistic approach.

Previous reports have suggested that dobutamine stress echocardiography compares favourably with other stress agent-imaging modality combinations for the detection of coronary artery disease. However, in daily clinical practice the value of a test is defined on a probability basis. To study the relative diagnostic contribution of clinical and dobutamine stress test variables, Bayesian analysis was performed in 223 patients with suspected coronary artery disease, who underwent coronary angiography and a high-dose dobutamine stress test in conjunction with electrocardiography, echocardiography and Technetium-99m sestamibi SPECT myocardial perfusion scintigraphy. According to the pre-test (clinical) probabilities, patients were divided into low-, intermediate- and high-risk groups; 155 patients were in the intermediate-risk group. After dobutamine stress echocardiography the number of patients in this intermediate-risk group was reduced to 102 (P < 0.0001). This reduction of patients in the intermediate-risk group by echocardiography was better than perfusion scintigraphy (102 vs 126 patients, P < 0.05) or classic markers of ischaemia such as angina and/or ST-segment changes (102 vs 150, P < 0.0001). Moreover, there was a good correlation between the echocardiographic post-test probabilities and the true distribution of coronary artery disease.

Aged↗
PubMed1994

Prediction of improvement of ventricular function after first acute myocardial infarction using low-dose dobutamine stress echocardiography.

This study was performed to assess the prevalence of spontaneous improvement of regional left ventricular function in patients after acute myocardial infarction, and to evaluate the role of low-dose dobutamine stress echocardiography for its prediction. In 57 patients with a first acute myocardial infarction (thrombolysis, n = 27; Q-wave, n = 49), regional wall motion was evaluated with 2-dimensional echocardiography at rest, during a low-dose dobutamine stress test performed within 1 week after hospital admission, and at 3-month follow-up. Myocardial viability was considered if there was an improvement of > or = 1 grade in dyssynergic segments from rest to low-dose dobutamine infusion; recovery of regional function was defined as an improvement of > or = 1 grade between rest and follow-up echocardiograms. Wall motion score index decreased from rest to low-dose dobutamine echocardiography (1.46 +/- 0.29 to 1.39 +/- 0.30, p < 0.0001), and this change persisted at follow-up study (1.37 +/- 0.30). No differences were found between patients who did and did not undergo thrombolyis, or between those who had Q-wave and non-Q-wave infarction. At baseline echocardiography, 189 of 627 segments were dyssynergic (85 hypokinetic, 104 akinetic). Viability at low-dose dobutamine stress echocardiography was more frequent in hypokinetic than in akinetic segments (30 of 85 vs 12 of 104, odds ratio 4.18, 95% confidence interval [CI] 1.87 to 9.48).(ABSTRACT TRUNCATED AT 250 WORDS)

Dobutamine↗
PubMed1994

Safety of dobutamine-atropine stress echocardiography in patients with suspected or proven coronary artery disease.

The purpose of this study was to establish the safety of high-dose dobutamine-atropine stress echocardiography in patients with suspected or proven coronary artery disease. Six hundred fifty consecutive examinations were completed. Mean age of patients was 61 years; 300 had a previous myocardial infarction. Heart rate increased from 73 to 129 beats/min during stress testing, blood pressure did not change significantly (from 140/81 to 150/80 mm Hg). Atropine was added to dobutamine in 239 patients when no ischemia was induced with dobutamine alone and the peak heart rate was < 85% of the theoretical maximal heart rate. Atropine was more frequently administered to patients taking beta blockers (77 vs 27%, p < 0.001). New wall motion abnormalities developed in 243 patients (37%). Significant or symptomatic cardiac tachyarrhythmias, or both, developed during 24 examinations: 1 patient developed ventricular fibrillation, 3 patients developed sustained ventricular tachycardia, 12 patients experienced nonsustained ventricular tachycardia (< 10 beats) and 8 patients had paroxysmal atrial fibrillation. Cardiac arrhythmias were more frequent in patients with a history of ventricular arrhythmias (ventricular tachycardia and fibrillation) (odds ratio 9.9, 2.0 to 45) or left ventricular dysfunction at rest (wall motion score > 1.12) (odds ratio 2.9, 1.1-7.6), but not associated with atropine addition. No death or myocardial infarction occurred. The full dose was not given to 13 patients despite absence of signs or markers of ischemia for limiting side effect, yielding an overall feasibility of the stress test of 98%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Dobutamine-atropine stress echocardiography and clinical data for predicting late cardiac events in patients with suspected coronary artery disease.

PURPOSE: To compare the relative value of clinical variables with dobutamine-atropine stress echocardiography to predict cardiac events during long-term follow-up. Dobutamine stress echocardiography is increasingly used for the detection of coronary artery disease, but little is known of its prognostic value. PATIENTS AND METHODS: A total of 430 patients (310 men; mean age 61 years, range 22 to 90) were enrolled in the study. Patients were referred for chest pain complaints and were unable to perform an adequate exercise stress test. All patients underwent dobutamine-atropine stress test (incremental dobutamine infusion: 10 to 40 micrograms/kg/minute, continued with atropine 0.25 to 1 mg intravenously if necessary to achieve 85% of the age predicted maximal heart rate, without symptoms or signs of ischemia) and clinical cardiac evaluation. Follow-up was 17 +/- 5 months, with a minimum of 6 months; 3 patients were lost to follow-up. Cardiac events were defined as cardiac death, nonfatal myocardial infarction, and coronary revascularization. RESULTS: Seventy-nine cardiac events occurred in 76 patients: cardiac death (n = 11), nonfatal myocardial infarction (n = 18), and coronary revascularization (n = 50). By multivariate regression analysis, the prognostic value of the stress test in addition to common clinical variables was assessed. (1) Cardiac death was predicted by age greater than 70 years (odds ratio 5.6, 1.5 to 20) or new wall motion abnormalities in a study that is normal at rest (odds ratio 4.1, 1.1 to 15). (2) Death or myocardial infarction was predicted by a history of myocardial infarction (odds ratio 4.8, 1.8 to 13) or age greater than 70 years (odds ratio 2.3, 1.1 to 5.4), and the stress test outcome provided no additional information. (3) If all events were combined, only stress test results were prognostic: new wall motion abnormalities in a study that is normal at rest (odds ratio 3.1, 1.9 to 5.1), wall motion abnormalities at rest (wall motion score at rest > or = 1.12) (odds ratio 2.5, 1.4 to 4.0), or any new wall motion abnormalities during stress (odds ratio 2.0, 1.4 to 3.8). The positive predictive value of any new wall motion abnormality during stress for all late cardiac events was 25% (95% confidence interval [CI] 19 to 31) with a negative predictive value of 87% (95% CI 83 to 91). CONCLUSION: In a large cohort of unselected patients with chest pain syndromes, new wall motion abnormalities induced by dobutamine provide additional information for late cardiac events, independent of clinical variables.

Adult↗
PubMed1994

Optimal use of directional coronary atherectomy is required to ensure long-term angiographic benefit: a study with matched procedural outcome after atherectomy and angioplasty.

OBJECTIVES: This study was designed to examine whether restenosis is related to the extent or mechanism of lumen improvement and to explore angiographic determinants of optimal atherectomy. BACKGROUND: Directional atherectomy induces a greater extent of immediate gain and late loss but has not been found to yield a better late angiographic lumen than angioplasty in randomized trials. The difference in lumen renarrowing may be related to either the extent or the mechanism of immediate gain. The design of previous studies has precluded the detection of a device-specific effect on restenosis. METHODS: A retrospective analysis was based on matching a prospectively collected series of 80 native coronary arteries successfully treated with atherectomy with a prospectively collected series of 80 native coronary arteries successfully treated with balloon angioplasty. Angiographic analysis was performed in 160 lesions to explore whether a specific device-related effect exists. Multivariate analyses were performed to determine the correlates of minimal lumen diameter at follow-up and late lumen loss and to identify the procedural characteristics for optimal atherectomy. RESULTS: Matching resulted in two comparable groups with equivalent baseline clinical and stenosis characteristics. By study design, atherectomy and angioplasty resulted in similar mean (+/- SD) immediate lumen gain (1.15 +/- 0.44 vs. 1.10 +/- 0.40 mm, p = 0.50). However, lumen loss was more pronounced after atherectomy, and, thus, the minimal lumen diameter at follow-up differed significantly between the two groups (1.78 +/- 0.57 vs. 2.00 +/- 0.56 mm, p = 0.001). Device type was retained in the multivariate analysis as an independent predictor of late minimal lumen diameter and lumen loss. Multivariate analysis identified vessel size and immediate gain as determinants of optimal atherectomy. CONCLUSIONS: Restenosis is a consequence not only of the extent of lumen improvement but also of the mechanism of vessel wall injury (debulking vs. dilating). While performing atherectomy, the operator should strive for an optimal procedural result to accommodate an increased intimal hyperplastic response.

Angioplasty, Balloon↗
PubMed1994

Quantitative coronary angiography in the estimation of the functional significance of coronary stenosis: correlations with dobutamine-atropine stress test.

OBJECTIVES: The purpose of this study was to determine the predictive value of quantitative coronary angiography in the assessment of the functional significance of coronary stenosis as judged from the development of left ventricular wall motion abnormalities during dobutamine-atropine stress echocardiography. BACKGROUND: Coronary angiography is the reference method for assessment of the accuracy of noninvasive diagnostic imaging techniques to detect the presence of significant coronary stenosis. However, use of arbitrary cutoff criteria for the interpretation of angiographic data may considerably influence the true diagnostic accuracy of the technique investigated. METHODS: Thirty-four patients without previous myocardial infarction and with single-vessel coronary stenosis were studied with both quantitative angiography and dobutamine-atropine stress echocardiography. Two different techniques of quantitative angiographic analysis--edge detection and videodensitometry--were used for measurement of minimal lumen diameter, percent diameter stenosis and percent area stenosis. Two-dimensional echocardiographic images were collected during incremental doses of intravenous dobutamine and later analyzed using a 16-segment left ventricular model. Angiographic cutoff criteria were derived from receiver-operating curves to define the functional significance of coronary stenosis on the basis of dobutamine-atropine stress echocardiography. RESULTS: The angiographic cutoff values with the best predictive value for the development of left ventricular wall motion abnormalities during dobutamine-atropine stress echocardiography were minimal lumen diameter of 1.07 mm, percent diameter stenosis of 52% and percent area stenosis of 75%. Minimal lumen diameter was found to have the best predictive value for a positive dobutamine stress test (odds ratio 51, sensitivity 94%, specificity 75%). CONCLUSIONS: Automated quantitative angiographic measurement of minimal lumen diameter is a practical and useful index for determining both the anatomic and functional significance of coronary stenosis, and a value of 1.07 mm is the best predictor for a positive dobutamine stress test.

Adult↗
PubMed1994

Dobutamine-atropine stress echocardiography for assessment of perioperative and late cardiac risk in patients undergoing major vascular surgery.

OBJECTIVE: To determine the value of dobutamine-atropine stress echocardiography and clinical variables to predict perioperative and late cardiac events in patients scheduled for elective major non-cardiac vascular surgery. DESIGN: Blinded prospective study. PATIENTS: Patients (n = 187 mean age 69 yrs). MEASUREMENTS: Dobutamine-atropine stress test was performed preoperatively. Results were not used for clinical management. The clinical risk profile was evaluated by Detsky's score. RESULTS: Technically adequate images were obtained in 185/187 patients, one major complication occurred (ventricular fibrillation) and four tests were prematurely stopped due to side effects. Data from 181 patients were analysed. The stress test was positive (new or worsened wall motion abnormality) in 56/181 patients. Perioperative cardiac events were: five fatal myocardial infarctions, three non-fatal myocardial infarctions, nine unstable angina pectoris and one pulmonary edema. All patients with a cardiac event had a positive stress test (18/56). No event occurred in patients with a negative stress test. By multivariate analysis only a new wall motion abnormality during the stress test (odds ratio 45.0, 6-369) was a significant predictor of cardiac events. Patients (n = 154) were followed after operation for 16 +/- 9 months. Twenty-four cardiac events occurred in 21 patients: six fatal myocardial infarctions, three non-fatal myocardial infarctions, six unstable angina pectoris, three ventricular arrhythmias and six congestive heart failures. The stress echo was positive in 19/21 patients with late cardiac events. The cardiac events correlated by multivariate analysis with a history of myocardial infarction (odds ratio 9.6, 1.9-47.7) and new wall motion abnormalities (odds ratio 6.2, 1.5-25.1). CONCLUSION: Dobutamine-atropine stress echocardiography is a relatively safe and useful test to identify patients at risk of perioperative and late postoperative cardiac events.

Aged↗
PubMed1994

Atropine increases the accuracy of dobutamine stress echocardiography in patients taking beta-blockers.

Dobutamine-atropine stress echocardiography is used for the non-invasive diagnosis of coronary artery disease, but stress test results may be influenced by beta-blockers. The aim of this study was to assess if the addition of atropine can compensate for the presence of beta-blockers in dobutamine stress echocardiography. Twenty-six patients referred for evaluation of chest pain were studied twice, on and off metoprolol 100 mg b.i.d. (in random order sequence) with a wash-out period of at least 48 h. Dobutamine stress echocardiography was performed using up to 40 micrograms.kg-1.min-1, followed, if necessary, by the addition of atropine to achieve 85% of the age-predicted maximal heart rate, unless symptoms or markers of ischaemia appeared. Atropine was given to patients on beta-blockers more often [(22/26) vs (6/26)] than to those off beta-blockers (P < 0.001). Heart rate at every stage of the test was lower on beta-blockers. Chest pain occurred in patients on beta-blockers significantly less than in those off beta-blockers (8% vs 46%), and the addition of atropine made no significant difference (31% vs 46%). During dobutamine stress, new wall motion abnormalities occurred in three patients on beta-blockers (12%); this number increased to 15 after the addition of atropine (57%). New or worsened wall motion abnormalities occurred in 12 patients (46%) off beta-blockers with dobutamine alone and in 14 patients after adding atropine (53%).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Dobutamine stress echocardiography for assessment of perioperative cardiac risk in patients undergoing major vascular surgery.

BACKGROUND: The purpose of this study was to determine the predictive value of dobutamine stress echocardiography for perioperative cardiac events in patients scheduled for elective major noncardiac vascular surgery. METHODS AND RESULTS: Patients (n = 136; mean age, 68 years) unable to exercise underwent a dobutamine stress test before surgery (incremental dobutamine infusion [10-40 micrograms.kg-1.min-1] continued with atropine [0.25-1 mg i.v.] if necessary to achieve 85% of the age-predicted maximal heart rate without symptoms or signs of ischemia). The clinical risk profile was evaluated by Detsky's modification of Goldman's risk factor analysis. Echocardiographic images were evaluated by two observers blinded to the clinical data of the patients, and results of the test were not used for clinical decision making. Technically adequate images were obtained in 134 of 136 patients, one major complication occurred (ventricular fibrillation), and three tests were discontinued prematurely because of side effects. Finally, data from 131 patients were analyzed with univariate and multivariate methods. The dobutamine stress test was positive (new or worsened wall motion abnormality) in 35 of 131 patients. In the postoperative period, five patients died of myocardial infarction, nine patients had unstable angina, and one patient developed pulmonary edema. All patients with cardiac complications (15 patients) had a positive dobutamine stress test. No cardiac events occurred in patients with negative tests. Five patients with a technically inadequate or prematurely stopped test were operated on without complications. By multivariate analysis (logistic regression), only age > 70 years and new wall motion abnormalities during the dobutamine test were significant predictors of perioperative cardiac events. CONCLUSIONS: Dobutamine stress echocardiography is a feasible, safe, and useful method for identifying patients at high or low risk of perioperative cardiac events. The test yields additional information, beyond that provided by clinical variables, in patients who are scheduled for major noncardiac vascular surgery.

Adult↗
PubMed1993

Intracranial hemorrhage after thrombolytic therapy. A perspective.

The most feared complication of thrombolytic therapy is intracranial hemorrhage. Nevertheless, the benefits of thrombolysis far outweight the potential hazards of a cerebral bleed. In individual patients the expected benefit of thrombolytic therapy can be estimated by subtraction of the risk for intracranial hemorrhage from the predicted gain in survival. Accordingly, the net effect of thrombolysis will be beneficial in most patients who can be treated within the first 12 hours after symptom onset, even if one or two risk factors for intracranial hemorrhage can be identified. On the other hand, thrombolytic therapy is not warranted in elderly patients with a relatively small predicted infarct size and multiple risk factors for intracranial hemorrhage.

Cerebral Hemorrhage↗
PubMed1990

[Penetrating injuries of the abdomen on the island Curaçao].

A retrospective study was conducted in 60 patients with stab or gunshot wounds to assess whether selective management is also justified if personnel involved has not had a great deal of experience. With selective management the results of the physical examination determine whether a laparotomy will or will not be performed.

Abdominal Injuries↗
PubMed1988

Changes in the spontaneous flight activity of the mosquito Anopheles stephensi by parasitization with the rodent malaria Plasmodium yoelii.

An acoustic actograph was used to monitor for 17 days after infection the spontaneous flight activity of the mosquito Anopheles stephensi parasitized with the rodent malaria Plasmodium yoelii. Activity fell to approximately two-thirds of control levels at about day 10 post-infection--when oocysts were reaching maximum size and starting to rupture (mean number of oocysts = 92)--and thereafter remained at this reduced level. The circadian activity pattern was not affected by the parasitism.

Animals↗
PubMedDate not supplied

Dobutamine-atropine stress echocardiography in elderly patients unable to perform an exercise test. Hemodynamic characteristics, safety, and prognostic value.

OBJECTIVE: To establish the hemodynamic effects, safety, and prognostic value of dobutamine-atropine stress echocardiography in patients 70 years of age or older. DESIGN AND SETTING: Observational study at a university hospital. PATIENTS: One hundred seventy-nine patients (mean age, 75 years; range, 70 to 90 years) referred for chest pain (n = 73) or preoperative risk assessment for major vascular noncardiac surgery (n = 106). MEASUREMENTS: All patients underwent clinical evaluation and dobutamine-atropine stress test. RESULTS: One hundred seventy-nine stress tests were performed. Test end points were the target heart rate (85% of theoretical maximum heart rate), reached in 165 tests (92%); inadequate echo images, two tests (1%); and side effects, 12 tests (7%). Side effects that caused a premature end of the test were severe chest pain (n = 5 [2.8%]), electrocardiographic changes (n = 1 [0.6%]), hypotension (n = 2 [1.1%]), chills (n = 2 [1.1%]), and cardiac arrhythmias (paroxysmal atrial fibrillation) (n = 2 [1.1%]). New wall motion abnormalities as a marker of myocardial ischemia occurred in 50 tests (28%). No death or myocardial infarction occurred during the test. Perioperative events occurred in 12 patients (four cardiac deaths, three myocardial infarctions, and five episodes of unstable angina). During 16 +/- 6 months (mean +/- SD) of follow-up of 166 patients, 22 cardiac events occurred (eight cardiac deaths, four myocardial infarctions, and 10 episodes of unstable angina pectoris). By multivariate regression analysis, only perioperative cardiac events (odds ratio, 51; 95% confidence interval, 5.8 to 454) and late cardiac events (odds ratio, 5.2; 95% confidence interval, 2.0 to 14) were correlated with new wall motion abnormalities during stress. CONCLUSION: Dobutamine-atropine stress echocardiography is a feasible and safe test for assessing elderly patients with suspected and/or proven coronary artery disease, providing useful prognostic information for perioperative and late cardiac risk with relatively few side effects.

Aged↗
PubMedDate not supplied

Individual risk assessment for intracranial haemorrhage during thrombolytic therapy.

Thrombolytic therapy improves outcome in patients with myocardial infarction but is associated with an increased risk of intracranial haemorrhage. For some patients, this risk may outweigh the potential benefits of thrombolytic treatment. Using data from other studies, we developed a model for the assessment of an individual's risk of intracranial haemorrhage during thrombolysis. Data were available from 150 patients with documented intracranial haemorrhage and 294 matched controls. 49 patients with intracranial haemorrhage and 122 controls had been treated with streptokinase, whereas 88 cases and 148 controls had received alteplase. By multivariate analysis, four factors were identified as independent predictors of intracranial haemorrhage; age over 65 years (odds ratio 2.2 [95% Cl 1.4-3.5]), body weight below 70 kg (2.1 [1.3-3.2]), hypertension on hospital admission (2.0 [1.2-3.2]), and administration of alteplase (1.6 [1.0-2.5]). If the overall incidence of intracranial haemorrhage is assumed to be 0.75%, patients without risk factors who receive streptokinase have a 0.26% probability of intracranial haemorrhage. The risk is 0.96%, 1.32%, and 2.17% in patients with one, two, or three risk factors, respectively. We present a model for individual risk assessment that can be used easily in clinical practice.

Age Factors↗
PubMedDate not supplied

Safety and feasibility of dobutamine-atropine stress echocardiography in patients with ischemic left ventricular dysfunction.

The aim of this study was to analyze whether left ventricular dysfunction affects the safety and feasibility of high-dose dobutamine-atropine stress echocardiography. We examined the results of the test in 318 consecutive patients who were referred for high-dose dobutamine-atropine stress echocardiography and also underwent diagnostic cardiac catheterization. Forty-four patients had a left ventricular ejection fraction of 25% or less (mean, 21%; range, 15% to 25%). In the entire group of 318 patients, no serious complications (death, myocardial infarction, or ventricular fibrillation) occurred. The overall feasibility of completing the test was excellent (97%). A trial fibrillation occurred in four patients, nonsustained ventricular tachycardia in 12, and sustained ventricular tachycardia in one. A decrease in systolic blood pressure of greater than 40 mm Hg or a peak systolic pressure of less than 80 mm Hg was present in eight cases. In the group with an ejection fraction of 25% or less, there was a higher rate of significant tachyarrhythmias (14% versus 5%; p = 0.03), whereas the feasibility of the test was slightly lower (89%; p < 0.01), but no difference for hypotension was found. By multivariate analysis, a history of tachyarrhythmias was the only predictor of stress-induced arrhythmias. Advanced left ventricular dysfunction does not represent a contraindication for dobutamine-atropine stress testing.

Adrenergic beta-Agonists↗
PubMedDate not supplied

Agreement and disagreement between "metabolic viability" and "contractile reserve" in akinetic myocardium.

BACKGROUND: In patients with chronic coronary artery disease and depressed left ventricular function, assessment of residual viability in akinetic myocardium is important for therapeutic management. Intact perfusion, preserved metabolism, and presence of contractile reserve are different aspects of cellular viability. However, not all viable cells exhibit all characteristics; it is thought that contractile reserve is less often preserved compared with metabolic activity or intact perfusion. In this study we performed a direct comparison between perfusion imaging with thallium-201 single photon emission computed tomography (SPECT), metabolic imaging with F18-fluorodeoxyglucose SPECT, and assessment of contractile reserve with low-dose dobutamine echocardiography in akinetic myocardium. METHODS AND RESULTS: Forty patients with depressed left ventricular function (mean left ventricular ejection fraction 31% +/- 16%) were studied. Resting echocardiography showed akinesis in 165 (32%) segments. Most (n = 154, 93%) of these segments demonstrated resting hypoperfusion. F18-fluorodeoxyglucose imaging revealed a perfusion-metabolism mismatch in 41 segments and a match in 113 segments. Contractile reserve was present in 33 (80%) of the segments with a perfusion-metabolism mismatch and in 7 (6%) segments with a match (P < .0005). Of the 11 segments with normal perfusion, only 5 (45%) showed contractile reserve. The agreement between SPECT and dobutamine echocardiography was 87%. Although 94% of the segments that were nonviable on scintigraphy did not show contractile reserve, the disagreement between SPECT and dobutamine echocardiography was caused mainly by the absence of contractile reserve in 27% of the segments that were viable on scintigraphy. CONCLUSION: This study shows a good agreement between SPECT and dobutamine echocardiography, although a substantial number of segments with preserved viability on SPECT do not exhibit contractile reserve, indicating underestimation of viability by dobutamine echocardiography compared with F18-fluorodeoxyglucose imaging.

Coronary Disease↗