722-3 Low Dose Dobutamine Predicts Recovery of Global but not Regional Left Ventricular Function After Revascularlzatlon In Patients with Chronic Ischemic Dysfunction

Abstract

The purpose of this study was to evaluate the ability of low dose (LD) dobutamine stress echocardiography (DSE) to independently predict recovery of global and regional left ventricular (LV) function following coronary artery bypass surgery (CABG) in patients with ischemic LV dysfunction. Sixteen patients with multivessel coronary artery disease and reduced ejection fraction (EF = 0.25 ± 0.08) underwent DSE prior to CABG, and 2D echo at 20 ± 17 weeks post-CABG (FlU). Global EF was measured at baseline, LD and at F/U; improvement was defined as an increase in EF of > 0.05. Global EF at F/U improved in 11/16 pts (69%). All 11 (100%) pts had improvement in EF on LD DSE. Improvement in regional function was assessed in segments (segs) that were akinetic (AK) or severely hypokinetic (SHK) at baseline. Of 147 SHK/AK segs at baseline, 27 (18%) had LD augmentation; of these 27 segs, 13 (48%) improved on FlU. Of 120 SHK/AK which did not augment at LD, 34 (28%) improved at F/U. The sensitivity (SENSI). specificity (SPECI), positive (PPV) and negative predictive values (NPV) of LD augmentation for predicting improvement in regional and global LV function were: SENSI SPECI PPV NPV p Regional 38% 86% 48% 72% * 0.05 * Global 100% 60% 85% ‡ 100% 0.02 ‡ 1) Improvement in EF during LD DSE predicts recovery of global LV function with a PPV of 85%, and 2) Failure of individual AK or SHK segments to improve with LD DSE predicts lack of recovery at F/U with a NPV of 72%. Low dose dobutamine stress echocardiography can therefore be used to predict recovery of global function and lack of recovery of regional ventricularfunction following revascularization in patients with chronic ischemic dysfunction. It may be of relative greater value in predicting global as compa red to regional function.