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

AIMS: This study investigated the functional outcome of wall-thinned,akinetic myocardium after revascularization and evaluated theaccuracy of dobutamine echocardiography in predicting post-revascularizationfunctional recovery with the assessment of end-diastolic wallthickness in chronic ischaemic patients. METHODS AND RESULTS: Fifty-three patients underwent dobutamine echocardiography beforecoronary revascularization. End-diastolic wall thickness wasalso evaluated before and after revascularization. The sensitivityand specificity of dobutamine echocardiography to predict post-revascularizationfunctional recovery were 69% and 100% in 58 akinetic/dyskineticsegments, and 86% and 57% in 96 hypokinetic segments. Of 19akinetic/dyskinetic segments with a preserved end-diastolicwall thickness, 17 (89%) showed functional recovery after revascularization,and dobutamine detected 14 (83%) of these 17 segments. Of 39akinetic/dyskinetic segments with a thinned end-diastolic wallthickness, 15 (38%) achieved functional recovery, whereas dobutamineechocardiography detected recovery in only eight (53%). Further,of these 15 viable, wall-thinned segments, 12 (80%) showed anincreased end-diastolic wall thickness after revascularization(mean±SD were from 5·6±0·7 mm atbaseline to 7·4±1·3 mm and 9·7±1mm after 1 week and after 3 months, respectively), and only5 (42%) of these responded to dobutamine. CONCLUSION: Dobutamine echocardiography showed a lessened sensitivity topredict post-revascularization functional recovery in akinetic/dyskineticsegments with a thinned end-diastolic wall thickness that subsequentlyincreased in size.