Accuracy of Dobutamine Stress Echocardiography in Detecting Recovery of Contractile Reserve after Revascularization of Ischemic Myocardium

Abstract

Background: This study was designed to investigate the accuracy of dobutamine stress echocardiography (DSE) in detecting the post-revascularization recovery rate of contractile reserve (CR) in ischemic myocardium.

Methods: A total of 112 segments from seven patients with low ejection fraction (<35%) and coronary artery disease were evaluated with DSE one week before and 12 weeks after coronary artery bypass graft surgery (CABG). Sensitivity, specificity, and positive and negative predictive values of DSE for detecting the recovery rate of CR were calculated based upon their standard definition and were presented with 95% confidence intervals (CI).

Results: The mean baseline left ventricular ejection fraction was 31±4%, which reached 35±7% after CABG unremarkably. The recovery rates of resting function and CR were 18.2% and 50% for hypokinetic and 15.6% and 24.1 for akinetic segments respectively. Specificity, sensitivity, and positive and negative predictive values of DSE for detecting the recovery of CR were 83% (CI=69-97), 89% (CI=83-96), 94% (CI = 88-99), and 73 % (CI = 55-88), respectively.  

Conclusion: Despite acceptable sensitivity, specificity, and positive predictive value, DSE has a relatively lower negative predictive value for detecting the recovery of CR in ischemic myocardium and, consequently, the full extent of myocardial viability. Further sensitive techniques may, therefore, be needed to provide complementary information regarding long-term functional outcome.