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  • Title: The combined pharmacological stress echocardiography protocol for predicting viability in territories supplied by coronary arteries at varying degrees of obstruction.
    Author: Abdel-Salam Z, Nammas W.
    Journal: Kardiol Pol; 2010 Feb; 68(2):137-43. PubMed ID: 20301022.
    Abstract:
    BACKGROUND: Pharmacological stress echocardiography has gained wide acceptance for identification of myocardial viability. AIM: We sought to explore the diagnostic accuracy of the combined pharmacological stress echocardiography protocol to predict viability of myocardial segments supplied by arteries at varying degrees of stenosis/occlusion. METHODS: We enrolled 100 consecutive patients with significant coronary stenosis/occlusion, prior myocardial infarction, and regional wall motion abnormality in the distribution of the affected artery. All patients underwent assessment of global and regional left ventricular systolic function. Patients underwent 3 pharmacological stress echocardiography protocols: low dose dobutamine, infra-low dose dipyridamole, and combined protocols. They underwent thereafter successful coronary revascularisation either by percutaneous coronary angioplasty, or by surgical bypass grafting. Follow-up echocardiography was performed 8 weeks later. Segments were subdivided according to the severity of stenosis/occlusion of the supplying artery into 3 subgroups, namely: those supplied by totally occluded, critically stenosed, or subcritically stenosed arteries. Predicted recovery by any of the 3 protocols for each category of segments was compared with real contractility improvement after revascularisation. RESULTS: The combined protocol had a significantly higher sensitivity for predicting contractile recovery in all segment categories compared with the other 2 protocols. In addition, it had a similar specificity in segments supplied by subcritically stenosed arteries, though with a lower specificity in segments supplied by totally occluded and critically stenosed arteries when compared with the other two protocols. CONCLUSION: The combined pharmacological stress protocol would better predict viability, as compared to the low dose dobutamine and the infra-low dose dipyridamole protocols, particularly in segments supplied by subcritically stenosed arteries.
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