OBJECTIVE: To determine whether, compared with fundamental imaging, second harmonic imaging can improve the accuracy of dobutamine stress echocardiography for identifying viable myocardium, using nuclear imaging as a reference. PATIENTS: 30 patients with chronic left ventricular dysfunction (mean (SD) age, 60 (8) years; 22 men). METHODS: Dobutamine stress echocardiography was carried out in all patients using both fundamental and second harmonic imaging. All patients underwent dual isotope simultaneous acquisition single photon emission computed tomography (DISA-SPECT) with (99m)technetium-tetrofosmin/(18)F-fluorodeoxyglucose on a separate day. Myocardial viability was considered present by dobutamine stress echocardiography when segments with severe dysfunction showed a biphasic sustained improvement or an ischaemic response. Viability criteria on DISA-SPECT were normal or mildly reduced perfusion and metabolism, or perfusion/metabolism mismatch. RESULTS: Using fundamental imaging, 330 segments showed severe dysfunction at baseline; 144 (44%) were considered viable. The agreement between dobutamine stress echocardiography by fundamental imaging and DISA-SPECT was 78%, kappa = 0.56. Using second harmonic imaging, 288 segments showed severe dysfunction; 138 (48%) were viable. The agreement between dobutamine stress echocardiography and DISA-SPECT was significantly better when second harmonic imaging was used (89%, kappa = 0.77, p = 0.001 v fundamental imaging). CONCLUSIONS: Second harmonic imaging applied during dobutamine stress echocardiography increases the agreement with DISA-SPECT for detecting myocardial viability.

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Keywords *Myocardium, Cardiotonic Agents/*diagnostic use, Dobutamine/*diagnostic use, Echocardiography, Stress/*methods, Female, Fluorodeoxyglucose F18/diagnostic use, Humans, Male, Middle aged, Radiopharmaceuticals/diagnostic use, Sensitivity and Specificity, Tomography, Emission-Computed, Single-Photon/methods, Ventricular Dysfunction, Left/radionuclide imaging/*ultrasonography
Persistent URL hdl.handle.net/1765/8312
Sozzi, F, Poldermans, D, Bax, J.J, Elhendy, A, Vourvouri, E.C, Valkema, R, … Roelandt, J.R.T.C. (2001). Improved identification of viable myocardium using second harmonic imaging during dobutamine stress echocardiography. Heart, 86(6), 672–678. Retrieved from http://hdl.handle.net/1765/8312