Accuracy of biphasic response, sustained improvement and worsening during dobutamine echocardiography in predicting recovery of resting myocardial dysfunction after revascularization: comparison with thallium-201 SPECT.

To evaluate the accuracy of various types of wall motion response during dobutamine echocardiography (DE) in predicting functional recovery after revascularization, we studied 30 patients with stable coronary disease and left ventricular dysfunction by simultaneous DE and (201)Tl reinjection SPECT. Among 480 segments (16 segments/patient), 199 had abnormal wall motion at baseline and 167 were revascularized. The predictive value for recovery of function was 72% for a biphasic response, 61% for sustained improvement, 77% for worsening, and 27% for no change (p < 0.01 vs. each). Biphasic response had a sensitivity of 40% and specificity of 85%. Combining biphasic, sustained improvement and worsening responses, the sensitivity, specificity and accuracy were 76%, 65% and 71%, respectively. For (201)Tl SPECT, they were 90%, 65% and 78%, respectively. Thus, a biphasic response alone is of low sensitivity. Combination of biphasic, sustained improvement and worsening responses gives an accuracy rate comparable to that of (201)Tl reinjection SPECT in assessing functional recovery.