Sensitivity, specificity, and predictive accuracies of non-invasive tests, singly and in combination, for diagnosis of hibernating myocardium

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Abstract
Objective To determine the best test(s) for predicting functional recovery of hibernating myocardium after reperfusion. Methods A prospective study to compare echocardiographic left ventricular diastolic wall thickness (≥5mm), low-dose dobutamine echocardiography and rest-redistribution thallium-201 scintigraphy, alone and in combination, for predicting recovery of left ventricular akinesis after surgical revascularization. Results Twenty-eight consecutive patients aged 58±9 years were studied. Of the 448 left ventricular segments, 263 were akinetic at rest; 230/263 (87%) had wall thickness ≥5mm, 135 (51%) had a positive response and 175 (66·5%) were graded viable on thallium. Of akinetic segments 61% improved after surgery. Left ventricular score decreased from 2·3±0·4 to 1·8±0·4 (PPConclusions Diastolic wall thickness <5mm on echocardiography was the best simple and single predictor of non-recovery of left ventricular dysfunction. The addition of dobutamine echocardiography or thallium-201, but not both, was the best solution for predicting recovery of left ventricular dysfunction. In times of limited resources, these findings are important from a clinical point of view.

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