Dusuk doz dobutamin ile yapilan gated SPECT goruntulemenin sol ventrikul disfonksiyonu olan koroner arter hastalarinda revaskularizasyon sonrasi fonksiyonel duzelmeyi ongormedeki degeri

The present study sought to evaluate the value of gated SPECT imaging, which provides the opportunity to acquire function and perfusion information simultaneously, under infusion of low dose dobutamine in the prediction of functional recovery after revascularization in patients with coronary artery disease and left ventricular dysfunction. Sixteen patients with stable coronary artery disease and segmental ventricular dysfunction scheduled for PTCA underwent resting echocardiogram, rest gated SPECT and gated SPECT under infusion of 5-10 μg/kg/min dobutamine during acquisition on the same day, and rest/stress Tc-99m sestamibi standard perfusion imaging on a separate day before PTCA. The improvement of dyssynergic segments was determined with a rest echocardiogram 2 months after PTCA. A 16-segment model was used for interpretation of the echocardiograms and the SPECT images. Wall motion was scored on a 4-point scale (0=absent, 3=normal) on gated images and perfusion was scored on a 5-point scale (0=normal, 4=absent) on gated and standard perfusion images. On gated images, diagnostic criteria for viable dysfunctional segments were: a) wall motion score ≥2, b) perfusion score ≤2, c) a wall motion score change > 1 grade with dobutamine. On perfusion images, diagnostic criteria were taken as: a) reversible defect, b) fixed defect having >50% uptake of maximal activity. 104 segments demonstrated abnormal wall motion and 72 of them improved after revascularization. Dobutamine gated SPECT had a 86% sensitivity, 72% specificity and 82% diagnostic accuracy for predicting functional improvement. These values were 68%, 75% and 70%, respectively, for rest gated SPECT and 71%, 53% and 65%, for standard SPECT imaging. Gated imaging improved specificity and dobutamine perfusion improved sensitivity. Thus, dobutamine gated SPECT has a higher diagnostic accuracy and this method may have incremental value in the prediction of functional improvement after revascularization in patients with coronary artery disease and left ventricular dysfunction.