Prediction of recovery of myocardial dysfunction after revascularization comparison of fluorine-18 fluorodeoxglucose/Thallium-201 SPECT, thallium-201 Stress-Reinjection SPECT and dobutamine echocardiography

Objectives. We compared: three techniques to predict functional recovery after revascularization. Background. Recently, fluorine-18 (F-18) fluorodeoxyglucose in combination with single-photon emission computed tomography (SPECT) has been proposed to identify viable myocardium. Thallium-201 reinjection and 'low' dose dobutamine echocardiography are used routinely for this purpose. Methods. Seventeen patients (mean [±SD] left ventricular ejection fraction 36 ± 11%) were studied. Regional and global ventricular function were evaluated before and 3 months after revascularization by echocardiography and radionuclide ventriculography, respectively. Myocardial F-18 fluorodeoxyglucose uptake (during hyperinsulinemic glucose clamping) was compared with rest perfusion assessed with early thallium-201 SPECT. Oh a separate day, low dose dobutamine echocardiography and post-stress thallium-201 reinjection SPECT were simultaneously performed. Results. The sensitivities for F18 fluorodeoxyglucose/thallium-201, thallium-301 reinjection and low dose dobutamine echocardiography to assess recovery were 89%, 93% and 85%, respectively; specificities were 77%, 43% and 63%, respectively. Stepwise logistic regression indicated that F-18 fluorodeoxyglucose/ thallium-201 was the best predictor. In hypokinetic segments, the combination of F-18 fluorodeoxyglucose/thallium-201 and low dose dobutamine echocardiography was the best predictor. Global function improved (left ventricular ejection fraction increased > 5%) in 6 patients and remained unchanged in 11. All three techniques correctly identified five of six patients with improvement. Fluorine-18 fluorodeoxyglucose/thallium-201 identified all patients without improvement; low dose dobutamine echocardiography identified 9 of 11 without improvement; and thallium-201 reinjection identified 6 of 11 patients without improvement, Conclusions. Fluorine-18 fluorodeoxyglucose/thallium-201 SPECT was superior to the other techniques in assessing funct