An assessment of dobutamine echocardiography and end-diastolic wall thickness for predicting post-revascularization functional recovery in patients with chronic coronary artery disease

Abstract

Aims: This study investigated the functional outcome of wall-thinned, akinetic myocardium after revascularization and evaluated the accuracy of dobutamine echocardiography in predicting post-revascularization functional recovery with the assessment of end-diastolic wall thickness in chronic ischaemic patients. Methods and Results: Fifty-three patients underwent dobutamine echocardiography before coronary revascularization. End-diastolic wall thickness was also evaluated before and after revascularization. The sensitivity and specificity of dobutamine echocardiography to predict post-revascularization functional recovery were 69% and 100% in 58 akinetic/dyskinetic segments, and 86% and 57% in 96 hypokinetic segments. Of 19 akinetic/dyskinetic segments with a preserved end-diastolic wall thickness, 17 (89%) showed functional recovery after revascularization, and dobutamine detected 14 (83%) of these 17 segments. Of 39 akinetic/dyskinetic segments with a thinned end-diastolic wall thickness, 15 (38%) achieved functional recovery, whereas dobutamine echocardiography detected recovery in only eight (53%). Further, of these 15 viable, wall-thinned segments, 12 (80%) showed an increased end-diastolic wall thickness after revascularization (mean ± SD were from 5.6 ± 0.7 mm at baseline to 7.4 ± 1.3 mm and 9.7 ± 1.4 mm after 1 week and after 3 months, respectively), and only 5 (42%) of these responded to dobutamine. Conclusion: Dobutamine echocardiography showed a lessened sensitivity to predict post-revascularization functional recovery in akinetic/dyskinetic segments with a thinned end-diastolic wall thickness that subsequently increased in size.