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Abstract：
BACKGROUND: Dobutamine stress echocardiography (DSE) and myocardial perfusion scan are the commonly used modalities to detect viable myocardium. DSE is comparatively cheaper and widely available but has a lower sensitivity.
OBJECTIVE: We aimed to compare contrast-enhanced low-dose dobutamine echocardiography (LDDE) and gated 99mTc-sestamibi myocardial perfusion scan (MPS) for the degree of agreement in the detection of myocardial viability.
METHODS: We studied 850 left ventricular segments from 50 patients (42 men, mean age 55.5 years), with coronary artery disease and left ventricular systolic dysfunction (ejection fraction < 40%), using contrast-enhanced LDDE and 99mTc-Sestamibi gated SPECT. Segments were assessed for the presence of viability by both techniques and head to head comparisons were made.
RESULTS: Adequate visualisation increased from 80% in unenhanced segments to 96% in contrast-enhanced segments. Of the total 850 segments studied, 290 segments (34.1%) had abnormal contraction (dysfunctional). Among these, 138 were hypokinetic (16.2% of total), 144 were severely hypokinetic or akinetic (16.9% of total), and 8 segments were dyskinetic or aneurismal (0.9% of total). Among 151 segments considered viable by technetium, 137 (90.7%) showed contractile improvement with dobutamine; in contrast, only 8 of the 139 segments (5.7%) considered nonviable by technetium had a positive dobutamine response. The per cent of agreement between technetium uptake and a positive response to dobutamine was 78.6% with kappa = 0.63, suggestive of a substantial degree of agreement between the two modalities.
CONCLUSIONS: Use of contrast-enhanced LDDE significantly increased the adequate endocardial border visualisation. Furthermore, this study showed a strong degree of agreement between the modalities in the detection of viable segments. So, contrast-enhanced LDDE appears to be a safe and comparable alternative to MPS in myocardial viability assessment.
OBJECTIVE: We aimed to compare contrast-enhanced low-dose dobutamine echocardiography (LDDE) and gated 99mTc-sestamibi myocardial perfusion scan (MPS) for the degree of agreement in the detection of myocardial viability.
METHODS: We studied 850 left ventricular segments from 50 patients (42 men, mean age 55.5 years), with coronary artery disease and left ventricular systolic dysfunction (ejection fraction < 40%), using contrast-enhanced LDDE and 99mTc-Sestamibi gated SPECT. Segments were assessed for the presence of viability by both techniques and head to head comparisons were made.
RESULTS: Adequate visualisation increased from 80% in unenhanced segments to 96% in contrast-enhanced segments. Of the total 850 segments studied, 290 segments (34.1%) had abnormal contraction (dysfunctional). Among these, 138 were hypokinetic (16.2% of total), 144 were severely hypokinetic or akinetic (16.9% of total), and 8 segments were dyskinetic or aneurismal (0.9% of total). Among 151 segments considered viable by technetium, 137 (90.7%) showed contractile improvement with dobutamine; in contrast, only 8 of the 139 segments (5.7%) considered nonviable by technetium had a positive dobutamine response. The per cent of agreement between technetium uptake and a positive response to dobutamine was 78.6% with kappa = 0.63, suggestive of a substantial degree of agreement between the two modalities.
CONCLUSIONS: Use of contrast-enhanced LDDE significantly increased the adequate endocardial border visualisation. Furthermore, this study showed a strong degree of agreement between the modalities in the detection of viable segments. So, contrast-enhanced LDDE appears to be a safe and comparable alternative to MPS in myocardial viability assessment.
摘要：
背景：多巴酚丁胺负荷超声心动图（DSE）和心肌灌注扫描是检测存活心肌的常用方法。DSE相对便宜且广泛可用,但具有较低的灵敏度。
目的：我们旨在比较对比增强低剂量多巴酚丁胺超声心动图（LDDE）和门控99mTc-sestamibi心肌灌注扫描（MPS）在检测心肌活力方面的一致性程度。
方法：我们研究了50名患者的850个左心室节段（42名男性，平均年龄55.5岁)，冠状动脉疾病和左心室收缩功能障碍（射血分数<40％），使用对比增强LDDE和99mTc-Sestamibi门控SPECT。通过两种技术评估分段是否存在生存力，并进行头对头比较。
结果：充分的可视化从未增强节段的80%增加到对比增强节段的96%。在研究的850个细分市场中，290段（34.1％）异常收缩（功能失调）。其中,138例运动不足（占总数的16.2%），144人严重运动不足或运动异常（占总数的16.9％），8个节段是运动障碍或动脉瘤（占总数的0.9％）。在被认为可行的151个片段中，137（90.7％）显示多巴酚丁胺的收缩改善；相反，在被认为无法存活的139个片段中,只有8个(5.7%)的多巴酚丁胺反应呈阳性.of摄取与多巴酚丁胺的阳性反应之间的一致性百分比为78.6％，κ=0.63，表明两种方式之间的一致性程度很高。
结论：使用对比增强LDDE可显著提高心内膜边界的可视化效果。此外，这项研究表明，可行区段的检测方式之间有很强的一致性。所以,对比增强LDDE在心肌活力评估中似乎是MPS的一种安全且可比的替代方法.
目的：我们旨在比较对比增强低剂量多巴酚丁胺超声心动图（LDDE）和门控99mTc-sestamibi心肌灌注扫描（MPS）在检测心肌活力方面的一致性程度。
方法：我们研究了50名患者的850个左心室节段（42名男性，平均年龄55.5岁)，冠状动脉疾病和左心室收缩功能障碍（射血分数<40％），使用对比增强LDDE和99mTc-Sestamibi门控SPECT。通过两种技术评估分段是否存在生存力，并进行头对头比较。
结果：充分的可视化从未增强节段的80%增加到对比增强节段的96%。在研究的850个细分市场中，290段（34.1％）异常收缩（功能失调）。其中,138例运动不足（占总数的16.2%），144人严重运动不足或运动异常（占总数的16.9％），8个节段是运动障碍或动脉瘤（占总数的0.9％）。在被认为可行的151个片段中，137（90.7％）显示多巴酚丁胺的收缩改善；相反，在被认为无法存活的139个片段中,只有8个(5.7%)的多巴酚丁胺反应呈阳性.of摄取与多巴酚丁胺的阳性反应之间的一致性百分比为78.6％，κ=0.63，表明两种方式之间的一致性程度很高。
结论：使用对比增强LDDE可显著提高心内膜边界的可视化效果。此外，这项研究表明，可行区段的检测方式之间有很强的一致性。所以,对比增强LDDE在心肌活力评估中似乎是MPS的一种安全且可比的替代方法.
