Low-dose dobutamine echocardiography and rest-redistribution thallium-201 tomography in the assessment of spontaneous recovery of left ventricular function after recent myocardial infarction

Spontaneous improvement of contraction and perfusion occurs after acute myocardial infarction. The relative merit of low-dose dobutamine stress echocardiography (LDDE) and rest-redistribution thallium scintigraphy (RR TI) in this setting has not been evaluated. We studied 30 patients at 7 +/- 3 days after acute myocardial infarction with LDDE (5 to 10 mu g/kg/min) and RR ii single photon emission computed tomography. Viability was defined as improvement of wall thickening at LDDE in the presence of redistribution or a defect with uptake greater than or equal to 50% of peak activity at RR ii. Baseline echocardiography and RR TI were repeated after 3 months. In 112 dyssynergic segments, viability was detected in 60 (54%) by RR TI and in 39 (35%) by LDDE (p<0.005). Spontaneous improvement of function was detected in 35 (31%) segments. In the same regions, thallium uptake increased significantly. The sensitivity, specificity, and accuracy of LDDE for predicting late improvement of wall motion were 77%, 84%, and 82%, respectively. Those of RR TI were 77%, 57%, and 63%, respectively. Specificity and accuracy of LDDE were higher than RR TI (p<0.005). We conclude that a myocardial viability pattern after acute myocardial infarction is more frequently detected by RR TI than by LDDE. Both techniques are equally sensitive, but LDDE is a more specific predictor of spontaneous recovery of regional left ventricular function.