Sensitivity, specificity, and predictive accuracies of non-invasive tests, singly and in combination, for diagnosis of hibernating myocardium

G. Lacanna, S. H. Rahimtoola, O. Visioli, R. Giubbini, O. Alfieri, M. Zognio, E. Milan, C. Ceconi, M. Gargano, R. Lorusso, R. Ferrari

Research output: Contribution to journalArticlepeer-review

Abstract

Objective. To determine the best test(s) for predicting functional recovery of hibernating myocardium after reperfusion. Methods. A prospective study to compare echocardiographic left ventricular diastolic wall thickness (≥ 5 mm), low-dose dobutamine echocardiography and rest-redistribution thallium-201 scintigraphy, alone and in combination, for predicting recovery of left ventricular akinesis after surgical revascularization. Results. Twenty-eight consecutive patients aged 58 ± 9 years were studied. Of the 448 left ventricular segments, 263 were akinetic at rest; 230/263 (87%) had wall thickness 25 mm, 135 (51%) had a positive response and 175 (66.5%) were graded viable on thallium. Of akinetic segments 61% improved after surgery. Left ventricular score decreased from 2.3 ± 0.4 to 1.8 ± 0.4 (P <0.01) and ejection fraction increased from 27 ± 10 to 37 ± 14% (P <0.01). For predicting results at 1 year, diastolic wall thickness had a sensitivity and a predictive accuracy of a negative test of 100% but a specificity of 28% and predictive accuracy of a positive test of 61%. The addition of dobutamine echocardiography or thallium-201 improved the predictive accuracy of a positive test to 76% and 69%, respectively; the addition of both tests was not of greater benefit than that of a single test. Conclusions. Diastolic wall thickness <5 mm on echocardiography was the best simple and single predictor of non-recovery of left ventricular dysfunction. The addition of dobutamine echocardiography or thallium-201, but not both, was the best solution for predicting recovery of left ventricular dysfunction. In times of limited resources, these findings are important from a clinical point of view. (C) 2000 The European Society of Cardiology.

Original languageEnglish
Pages (from-to)1358-1367
Number of pages10
JournalEuropean Heart Journal
Volume21
Issue number16
DOIs
Publication statusPublished - Aug 15 2000

Keywords

  • Diastolic thickness
  • Dobutamine echocardiography
  • Hibernating myocardium
  • Thallium scintigraphy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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