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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Article Info
Publication History
Accepted:
March 3,
2003
Received in revised form:
March 3,
2003
Received:
January 7,
2003
Footnotes
☆This study was supported by the Hellenic Heart Foundation, Athens, Greece.
Identification
Copyright
© 2003 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
