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European Journal of Heart Failure 2007 9(4):403-408; doi:10.1016/j.ejheart.2006.10.018
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© 2007 European Society of Cardiology

Myocardial viability estimation during the recovery phase of stress echocardiography after acute beta-blocker administration

Stefanos E. Karagiannisa, Harm H.H. Feringaa, Jeroen J. Baxb, Abdu Elhendyc, Martin Dunkelgruna, Radosav Vidakovica, S.E. Hoeksa, Ron van Domburga, Roelf Valhemad, Dennis V. Cokkinose and Don Poldermansa,*

a Department of Cardiology Erasmus MC, Rotterdam, The Netherlands
b Department of Cardiology, Leiden University Leiden, The Netherlands
c Department of Cardiology, University of Omaha Nebraska, USA
d Department of Nuclear Medicine Erasmus MC, Rotterdam, The Netherlands
e 1st Department of Cardiology, Onassis Cardiac Surgery Centre Athens, Greece

* Corresponding author. Department of Cardiology, Room H 921, Erasmus MC, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. Tel.: +31 104639222; fax: +31 104634957. E-mail address: d.poldermans{at}erasmusmc.nl


  Abstract

Background: Myocardial viability assessment in severely dysfunctional segments by dobutamine stress echocardiography (DSE) is less sensitive than nuclear scanning.

Aim: To assess the additional value of using the recovery phase of DSE after acute beta-blocker administration for identifying viable myocardium.

Methods: The study included 49 consecutive patients with ejection fraction (LVEF) ≤35%. All patients underwent DSE evaluation at low–high dose and during recovery phase, and dual-isotope single photon emission tomography (DISA-SPECT) evaluation for viability of severely dysfunctional segments. Patients with ≥4 viable segments were considered viable. Coronary revascularization followed within 3 months in all patients. Radionuclide evaluation of LVEF was performed before and 12 months after revascularization.

Results: Viability with DISA-SPECT was detected in 463 (59%) segments, while 154 (19.7%) segments presented as scar. The number of viable segments increased from 415 (53%) at DSE to 463 (59%) at DSE and recovery, and the number of viable patients increased from 43 to 49 respectively. LVEF improved by ≥5% in 27 patients. Multivariate regression analysis showed that, DSE with recovery phase was the only independent predictor of ≥5% LVEF improvement after revascularization (OR 14.6, CI 1.4–133.7).

Conclusion: In this study, we demonstrate that the recovery phase of DSE has an increased sensitivity for viability estimation compared to low–high dose DSE.

Key Words: Dobutamine Stress Echocardiography • Recovery phase • Viability

Received May 30, 2006; Revised October 1, 2006; Accepted October 19, 2006


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