PREOPERATIVE SELECTION OF PATIENTS WITH SEVERELY IMPAIRED LEFT-VENTRICULAR FUNCTION FOR CORONARY REVASCULARIZATION - ROLE OF LOW-DOSE DOBUTAMINE ECHOCARDIOGRAPHY AND EXERCISE-REDISTRIBUTION-REINJECTION THALLIUM SPECT

Citation
Jlj. Vanoverschelde et al., PREOPERATIVE SELECTION OF PATIENTS WITH SEVERELY IMPAIRED LEFT-VENTRICULAR FUNCTION FOR CORONARY REVASCULARIZATION - ROLE OF LOW-DOSE DOBUTAMINE ECHOCARDIOGRAPHY AND EXERCISE-REDISTRIBUTION-REINJECTION THALLIUM SPECT, Circulation, 92(9), 1995, pp. 37-44
Citations number
36
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiac & Cardiovascular System",Hematology
Journal title
ISSN journal
0009-7322
Volume
92
Issue
9
Year of publication
1995
Supplement
S
Pages
37 - 44
Database
ISI
SICI code
0009-7322(1995)92:9<37:PSOPWS>2.0.ZU;2-B
Abstract
Background Both thallium imaging and low-dose dobutamine echocardiogra phy have been proposed to predict the reversibility of left ventricula r (LV) dysfunction in patients with coronary disease. The present stud y was designed to evaluate whether the use of these techniques during the preoperative assessment of coronary patients with depressed LV fun ction can improve our ability to identify those likely to have improve d LV function after surgery. Methods and Results Forty consecutive pat ients (age, 60+/-10 years) with coronary disease and an ejection fract ion less than or equal to 35% underwent dobutamine echocardiography (1 0 mu g/kg per minute) and exercise-redistribution-reinjection thallium single photon emission computed tomography (SPECT) before coronary re vascularization by bypass surgery (n=33) or angioplasty (n=7). Recover y of LV function was evaluated by echocardiography 5.3+/-2.4 months af ter revascularization. Ac According to the changes in end-systolic vol ume and ejection fraction after revascularization, the patients were c ategorized into groups with (n=19) and without (n=21) postoperative fu nctional improvement, defined as a >5% increase in ejection fraction a nd >10 mt decrease in end-systolic volume. Before revascularization, p atients with improved postoperative function had smaller end-diastolic volume and less wall motion abnormalities than those with persistent dysfunction. They also showed greater improvement of wall motion score with dobutamine (6.1+/-2.4 versus 1.8+/-4.2 grades, P<.001) and small er thallium defect score after exercise (38+/-12 versus 47+/-14 grades , P=.04). Discriminant analysis selected the improvement in wall motio n score with dobutamine and baseline end-diastolic volume as independe nt predictors of postoperative recovery. Consideration of both paramet ers allowed prediction of functional outcome in 84% of the patients wi th and 81% of those without postoperative improvement. Conclusions Amo ng the parameters commonly available be fore surgery in coronary patie nts with depressed LV function, the maintenance of significant inotrop ic reserve, the severity of LV remodeling, and the magnitude of the pe rfusion defect after exercise can predict the reversal of LV dysfuncti on after revascularization.