Negative Contractile Reserve With Low-Dose Dobutamine in Patients With Ischemic Cardiomyopathy Investigated by Gated Myocardial Perfusion SPECT

Jaume Candell-Riera, Guillermo Romero-Farina, Marta Milá, Santiago Aguadé-Bruix, Gemma Cuberas, David García-Dorado

Research output: Contribution to journalArticleResearchpeer-review

3 Citations (Scopus)

Abstract

Introduction and objectives: To investigate negative contractile responses in the left ventricle during lowdose dobutamine (LDD) gated single-photon emission computed tomography (SPECT) in patients with ischemic cardiomyopathy. Methods: Sixty-eight consecutive patients (mean age, 60±11 years; 7 male) with ischemic cardiomyopathy (i.e., left ventricular ejection fraction [LVEF] ≤40%) were evaluated using gated-SPECT at rest and during LDD infusion. Associations between a negative contractile reserve (i.e., a ≥1-grade improvement in wall thickening score with LDD infusion) and scintigraphic viability criteria and coronary angiography findings were analyzed. Results: Some 42.6% (29/68) of patients had a negative contractile reserve in one or more segments. In 14.7% (n=10), the LVEF decreased by ≥4% with LDD. These patients had more segments with a negative contractile reserve (2.8±2.5 vs. 0.87±0.40; P=.042), and the cut-off value on receiver operating characteristic curve analysis was ≥2 segments with a negative contractile reserve (sensitivity 70%, specificity 74%, positive likelihood ratio 2.71, negative likelihood ratio 0.40). Some 94% (74/79) of segments with a negative contractile reserve were in viable myocardium (i.e. normal or viable on scintigraphy). Twelve of 17 segments with akinesia or severe hypokinesia and a negative contractile reserve satisfied scintigraphic viability criteria, with the majority (10/12) lying in territories supplied by a patent coronary artery. Conclusions: A negative contractile reserve was not uncommon in patients with ischemic cardiomyopathy and was associated with a general decrease in left ventricular systolic function. It was observed mainly in myocardial segments that appeared viable on scintigraphy and were supplied by a patent coronary artery. © 2010 Sociedad Española de Cardiología.
Original languageEnglish
Pages (from-to)181-189
JournalRevista Espanola de Cardiologia
Volume63
Issue number2
DOIs
Publication statusPublished - 1 Feb 2010

Keywords

  • Coronary anatomy
  • Dobutamine
  • Gated-SPECT
  • Ischemic cardiomyopathy
  • Negative contractile reserve

Fingerprint Dive into the research topics of 'Negative Contractile Reserve With Low-Dose Dobutamine in Patients With Ischemic Cardiomyopathy Investigated by Gated Myocardial Perfusion SPECT'. Together they form a unique fingerprint.

Cite this