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Prediction of functional recovery of hibernating myocardium using harmonic power Doppler imaging and dobutamine stress echocardiography in patients with coronary artery disease

      Abstract

      The aim of this study was to compare the accuracy of harmonic power Doppler imaging (HPDI) and dobutamine stress echocardiography (DSE) in predicting recovery of myocardial function after bypass surgery. HPDI using triggering imaging with the administration of Levovist (Shering AG, Berlin, Germany) and DSE were performed in 34 patients (mean age 64 ± 5 years) with left ventricular dysfunction. A repeat echocardiogram at rest was performed 3 months after revascularization. Of the 408 revascularized dysfunctional segments, 188 (45%) improved on the repeat echocardiogram. HPDI exhibited overall similar sensitivity (88% vs 87%) and accuracy (74% vs 79%) but lower specificity (61% vs 72%, p<0.05) compared with DSE for predicting recovery of myocardial function. Only delayed opacification at the 1:8 triggering point, demonstrated in 62% of viable segments, exhibited higher sensitivity (63%) and positive (58%) and negative (66%) predictive values than early opacification at 1:4 (25%, p<0.001; 35%, p<0.001; and 49%, p<0.001, respectively) in predicting functional recovery. The presence of contrast enhancement within the revascularized area resulted in a significant improvement after revascularization in wall motion score index and ejection fraction compared with areas with residual contrast defect (1.9 ± 0.3 vs 2.3 ± 0.3, p<0.01; 36 ± 6% vs 29 ± 5%, p<0.01, respectively). Significant correlations were observed between the contrast score index and the follow-up wall motion score index (r = −0.67) and between the contrast score index and the follow-up ejection fraction change (r = 0.65). Triggered HPDI has high sensitivity in detecting hibernating myocardium and can accurately predict the potential for recovery of ischemic left ventricular dysfunction 3 months after revascularization.
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      References

        • Bolognese L.
        • Antoniucci D.
        • Rovai D.
        • Buonamici P.
        • Cerisano G.
        • Santoro G.M.
        • Marini C.
        • L’Abbate A.
        • Fazzini P.F.
        Myocardial contrast echocardiography versus dobutamine echocardiography for predicting functional recovery after acute myocardial infarction treated with primary coronary angioplasty.
        J Am Coll Cardiol. 1996; 28: 1677-1683
        • Laskar R.
        • Grayburn P.
        Assessment of myocardial perfusion with contrast echocardiography at rest and with stress.
        Prog Cardiovasc Dis. 2000; 43: 245-258
        • Gunda M.
        • Mulvagh S.
        Recent advances in myocardial contrast echocardiography.
        Curr Opin Cardiol. 2001; 16: 231-239
        • Wei K.
        • Jayaweera A.
        • Firoosh S.
        • Linka A.
        • Skyba D.
        • Kaul S.
        Quantification of myocardial blood flow with ultrasound-induced destruction of microbubbles administered as a constant venous infusion.
        Circulation. 1998; 97: 473-483
        • Swinburn J.
        • Lahiri A.
        • Senior R.
        Intravenous myocardial contrast echocardiography predicts recovery of dysynergic myocardium early after acute myocardium infarction.
        J Am Coll Cardiol. 2001; 38: 19-25
        • Ohmori K.
        • Cotter B.
        • Leistad E.
        • Bhargava V.
        • Wolf P.L.
        • Mizushige K.
        • DeMaria A.N.
        Assessment of myocardial postreperfusion viability by intravenous myocardial contrast echocardiography.
        Circulation. 2001; 103: 2021-2035
        • Ohmori K.
        • Cotter B.
        • Kwan L.
        • Mizughige K.
        • DeMaria A.
        Relation of contrast echo intensity and flow velocity to the amplification of contrast opacification produced by intermittent ultrasound transmission.
        Am Heart J. 1997; 134: 1066-1074
        • Haluska B.
        • Case C.
        • Short L.
        • Anderson J.
        • Marwick T.
        Effect of power Doppler and digital subtraction techniques on the comparison of myocardial contrast echocardiography with SPECT.
        Heart. 2001; 85: 549-555
        • Rocchi G.
        • Kasprzak J.
        • Galema T.
        • Jong N.
        • Cate F.
        Usefulness of power Doppler contrast echocardiography to identify reperfusion after acute myocardial infarction.
        Am J Cardiol. 2001; 87: 278-282
        • Heinle S.K.
        • Noblin J.
        • Goree-Best P.
        • Mello A.
        • Ravad G.
        • Mull S.
        • Mammen P.
        • Grayburn P.A.
        Assessment of myocardial perfusion by harmonic power Doppler imaging at rest and during dobutamine stress.
        Circulation. 2000; 102: 55-60
        • Shan K.
        • Nagueh S.
        • Zoghbi W.
        Assessment of myocardial viability with stress echocardiography.
        Cardiol Clin. 1999; 17: 539-553
        • Quinones M.A.
        • Waggoner A.D.
        • Reduto L.A.
        • Nelson J.G.
        • Young J.B.
        • Winters Jr, W.L.
        • Ribeiro L.G.
        • Miller R.R.
        A new, simplified and accurate method for determining ejection fraction with two-dimensional echocardiography.
        Circulation. 1981; 64: 744-753
        • Aggeli C.
        • Shimoni S.
        • Nagueh S.
        • Zoghbi W.
        Quantitative parameters of myocardial perfusion with contrast echocardiography in man.
        J Am Soc Echocardiogr. 2002; 15: 1432-1439
        • Eslasser A.
        • Muller K.
        • Skwara W.
        • Bode C.
        • Kubler W.
        • Vogt A.
        Severe energy deprivation of human hibernating myocardium as possible common pathomechanism of contractile dysfunction, structural degeneration and cell death.
        J Am Coll Cardiol. 2002; 39: 1189-1198
        • Shimoni S.
        • Fragogiannis N.
        • Aggeli C.
        • Shan K.
        • Quinones M.
        • Espada R.
        • Letsou G.
        • Lawrie G.
        • Winters W.
        • Readson M.
        • Zoghbi W.
        Microvascular structural correlates of myocardial contrast echocardiography in patients with coronary artery disease and left ventricular dysfunction. Implications for the assessment of myocardial hibernation.
        Circulation. 2002; 106: 950-956
        • Qureshi U.
        • Nagheh A.
        • Afridi I.
        • Vaduganathan P.
        • Blaustein A.
        • Verani M.S.
        • Winters W.L.
        • Zoghbi W.
        Dobutamine echocardiography and quantitative rest-redistribution 201Th tomography in myocardial hibernation. Relation of contractile reserve to 201Th uptake and comparative prediction of recovery of function.
        Circulation. 1997; 95: 626-635
        • deFilippi C.R.
        • Willett D.L.
        • Irani W.N.
        • Eichhorn E.J.
        • Velasco C.E.
        • Grayburn P.A.
        Comparison of myocardial contrast echocardiography and low-dose dobutamine stress echocardiography in predicting recovery of left ventricular function after coronary revascularization in chronic ischemic heart disease.
        Circulation. 1995; 92: 2863-2868
        • Nagueh S.F.
        • Vaduganathan P.
        • Ali N.
        • Blaustein A.
        • Verani M.S.
        • Winters W.L.
        • Zoghbi W.A.
        Identification of hibernating myocardium.
        J Am Coll Cardiol. 1997; 29: 985-993