Value of Dobutamine-Echocardiogram in Predicting Functional Recovery of Hypokinetic or Akinetic Myocardium After Coronary Revascularlsation

Abstract

In 40 patients with stable coronary artery disease, we prospectively tried to predict the recovery of left ventricular regional wall motion abnormalities. Echocardiographic examination was done before and 3 months after coronary artery bypass surgery (CABG), 16 distinct regions were judged as normal, mildly hypokinetic, severely hypokinetic or akinetic without knowing the results of CABG. Before CABG, dobutamine echocardiography (5 to 10 μ /kg bw/min iv) was done. Regions with improvement of wall motion during dobutamine infusion (Dob+) were expected to recover after CABG. Of 412 regions with wall motion abnormalities and angiographically proven successful revascularisation 315 were Dob+, 263 showed improved wall motion after CABG, 52 do not. Out of 97 regions without improvement after dobutamine, only 6 showed improved wall motion after CABG. Sensitivity of Dob+ is 97.8%, specificity 63.6%, positive predictive value 83.5%, negative predictive value 93.8%. Dobutamine Echocardiography is useful to predict improvement of wall motion after CABG in hypokinetic or akinetic regions and differentiates viable (hibernating) myocardium from scar tissue areas.