722-2 Predicting Viability and Functional Recovery with Dobutamine Echocardiography and Positron Emission Tomography

Positron emission tomography (PET) is considered the gold standard for detecting myocardial viability. Unfortunately, PET is limited by availability and cost. Dobutamine echocardiography (DE) may be a cost effective and more available method of detecting viability. This report compared DE with PET in 33 patients (pts) with advanced coronary disease using a 16 segment model for left ventricular wall motion and uptake of fluorodeoxyglucose (FDG). PET viability was defined as normal or mildly reduced uptake of FDG. DE viability was defined as preserved wall motion at rest or augmentation during DE. PET showed evidence of viability in 93% (157/169) of segments with normal rest wall motion, 85% (62/73) of mildly hypokinetic segments and 93% (68/73) of severely hypokinetic segments. DE and PET were concordant in only 41% (71/175) of akinetic segments (46 nonviable and 25 viable). To investigate this discordance we evaluated follow up echocardiograms (≥four weeks) after coronary bypass surgery in 8 pts with 36 akinetic segments at rest. The ability of PET and DE to predict functional recovery of wall motion is as shown:(+)PV(-)PVSensSpecPET0.440.850.850.44DE0.600.730.460.83PV=predictive valueConclusions1) Normal, mildly hypokinetic or severely hypokinetic rest wall motion on echo correlates strongly with PET evidence of viability. 2) For functional recovery of akinetic segments, PET is sensitive but not specific and DE is specific but not sensitive