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European Journal of Cardio-Thoracic Surgery, Vol 7, 325-330, Copyright © 1993 by European Association for Cardio-thoracic Surgery
O Alfieri, G La Canna, R Giubbini, A Pardini, M Zogno and C Fucci
Recovery of myocardial contraction represents an important target of
coronary revascularization and the preoperative recognition of viable
akinetic (hibernating) myocardium is a crucial point of the preoperative
investigation of patients with chronically depressed left ventricular
function. In 14 patients dobutamine infusion during echocardiography was
utilized to evoke the contractile reserve retained by viable akinetic
segments. Redistribution of thallium(TI)-201 after the rest injection was
also used to assess the viability of akinetic areas. The wall motion
response to dobutamine infusion predicted immediate postoperative
improvement in 85 of 93 segments (sensitivity 91.3%) and identified 25 of
the 32 segments which did not exhibit early postoperative improvement
(specificity 78.1%). Rest redistribution of TI-201 demonstrated high
sensitivity (93.0%) but low specificity (43.7%) for predicting the early
recovery of regional wall motion. When late recovery was also considered,
the specificity of this method increased to 64.0%. Rest distribution of
TI-201 identifies viability which is not necessarily associated with the
early recovery of function postoperatively. When the echo-dobutamine test
is positive, on the other hand, the recovery of function usually occurs
immediately after revascularization and the operative risk is expected to
be low even in the presence of severely compromised left ventricular
function.
ARTICLES
Recovery of myocardial function. The ultimate target of coronary revascularization
Division of Cardiac Surgery, Civic Hospital, Brescia, Italy.
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