Dobutamine echocardiography predicts functional outcome after revascularisation in patients with dysfunctional myocardium irrespective of the perfusion pattern on resting thallium-201 imaging.

OBJECTIVE: To evaluate whether the predictive value of dobutamine echocardiography for assessing contractile reserve was altered by differing patterns of regional myocardial perfusion. PATIENTS: 31 consecutive patients with symptomatic congestive heart failure (left ventricular ejection fraction < 35%) caused by coronary artery disease.
SETTING: A district general hospital.
METHODS: Thallium-201 perfusion imaging and low dose dobutamine (5-15 microg/kg/min) echocardiography were performed and resting echocardiography was repeated three months after revascularisation. Perfusion pattern and systolic wall thickening were compared using a 12 segment left ventricular model.
RESULTS: Of the 273 severely dysfunctional segments, 106 (39%) showed a normal perfusion and 167 (61%) an abnormal pattern. After revascularisation, recovery occurred in 71 of the segments with a normal perfusion pattern, and in these a dobutamine response was observed in 61 (86%); recovery also occurred in 56 segments with a mild to moderate abnormality of perfusion, and in these a dobutamine response was seen in 46 (81%) (NS). After revascularisation, the positive and negative predictive values for recovery of dysfunctional segments, where the majority were abnormally perfused, were 88% and 86%, respectively. Systolic wall thickening score indices improved from (mean (SD)) 3.21 (0.58) to 2. 6 (0.66) (p < 0.001) after revascularisation in dobutamine responsive patients (n = 24) compared with patients who did not show a dobutamine response (2.86 (0.65) and 3.13 (0.56), p = 0.61, respectively).
CONCLUSIONS: Dobutamine echocardiography predicted improvement of dysfunctional myocardium after revascularisation irrespective of the resting perfusion pattern seen.