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Document Details : Title: Does resting echocardiography predict a positive response to subsequent low-dose dobutamine stress echocardiography in patients with ischaemic cardiomyopathy? Author(s): Z. Abdel-Salam , W. Nammas Journal: Acta Cardiologica Volume: 67 Issue: 6 Date: 2012 Pages: 693-699 DOI: 10.2143/AC.67.6.2184672 Abstract : Objective: We explored the accuracy of resting echocardiographic and tissue Doppler parameters to predict a positive response by low-dose dobutamine stress echocardiography (DSE) in patients with ischaemic cardiomyopathy. Methods and results: We enrolled 100 consecutive patients with prior myocardial infarction, and a left ventricular ejection fraction (LVEF) < 35%. They underwent resting echocardiographic assessment of LVEF, wall motion score index (WMSI), mitral E and A peak velocities, E/A ratio, E peak deceleration time, isovolumetric relaxation time (IVRT), early mitral annular diastolic velocity (e’), and E/e’ ratio. Subsequently, they underwent low-dose DSE for assessment of myocardial viability. The presence of viability was defined by improvement of the regional wall motion score by ≥ 1 grade in ≥ 5 myocardial segments, with ≥ 20% reduction in WMSI compared with baseline evaluation. Thirty-six patients had a negative response to DSE (group I); 64 had a positive response (group II). Resting LVEF was higher, and resting WMSI lower in group II versus group I; E peak deceleration time and IVRT shorter in group I (P < 0.05 for all). Multivariable regression analysis identified LVEF, WMSI, and IVRT as the independent predictors of a positive response to DSE. A cutoff value of LVEF of > 25% predicted viability with a sensitivity of 85.9%, specificity 80.6%; WMSI of ≤ 2.6 had a sensitivity of 85.7%, specificity 61.1%; IVRT of > 60 msec had a sensitivity of 93.7%, specificity 47.2%. Conclusions: Resting LVEF > 25%, WMSI ≤ 2.6, and IVRT > 60 msec predicted viability with a high sensitivity; however, with the exception of LVEF, specificity was quite low. |
