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Heart 1998;79:281-288 ( March )
a Cardiothoracic Surgical Unit, Queen
Elizabeth Hospital, Birmingham,
UK, b Department of Cardiovascular
Medicine, Queen Elizabeth Hospital, c MRC-Cyclotron Unit, Imperial
College School of Medicine Hammersmith Hospital,
London, UK
Correspondence to: Professor Camici, MRC Cyclotron Unit, Hammersmith Hospital, Ducane Road, London W12 ONN, UK. email: paolo{at}cu.rpms.ac.uk
Accepted for publication 15 December 1977
Objective
To compare the predictive value of
dobutamine echocardiography (DE) and positron emission tomography (PET)
in identifying reversible chronic left ventricular (LV) dysfunction
(hibernating myocardium) in patients with coronary artery disease (CAD)
and overt heart failure.
Patients30 patients (four women) with CAD and
heart failure undergoing coronary artery bypass grafting (CABG).
MethodsMyocardial viability was assessed with DE
(5 and 10 µg/kg/min) and PET with [18F]
2-fluoro-2-deoxy-D-glucose (FDG) under hyperinsulinaemic euglycaemic clamp. Regional (echo) and global LV function (MUGA) were assessed at
baseline and six months after CABG.
Results192 of the 336 (57%) dysfunctional LV
segments improved function following CABG (hibernating) and the LV
ejection fraction (EF) increased from 23(7) to 32(9)% (p < 0.0001)
(in 17 patients > 5%). DE and PET had similar positive predictive
values (68% and 66%) in the identification of hibernating myocardium,
but DE had a significantly lower negative predictive value than PET (54% v 96%; p < 0.0001). A significant linear
correlation was found between the number of PET viable segments and the
changes in EF following CABG (r = 0.65; p = 0.0001).
Stepwise logistic regression identified the number of PET viable
segments as an independent predictor of improvement in EF > 5%,
whereas the number of DE viable segments, the baseline LVEF, and wall
motion were not.
ConclusionsDE has a higher false negative rate
than PET in identifying recoverable LV dysfunction in patients with
severe postischaemic heart failure. The amount of PET viable myocardium
correlates with the functional outcome following CABG.
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