Clinical parameters fail to identify patients with myocardial viability on functional testing
Aortic Valve Stenosis
Image Interpretation, Computer-Assisted
Detection of myocatdial viability is Important for management of patients with coronary artery disease (CAD) and ventricular dysfunction. Although viable myocardium can be accurately detected by additional tests, such as dobutamine echocardiography (DE), it is important to assess whether readily available clinical information can improve the selection of patients referred for viability testing. The purpose of this study was to determine if clinical findings predict the presence or absence of viability during DE. Data banks of participating institutions were searched from 1993 onward to identify patients with CAD and ventricular dysfunction that underwent DE. Patients were considered to have viable myocardium if at least 2 contiguous ventricular segments with abnormal wan motion (WM) at rest showed improvement in contractility during DE We studied 240 patients, 195 males, mean age 63±10 yrs. Viable myocardium was detected during DE in 175 (73%) patients. There was no difference in age between patients with and without viable myocardium (63±10 vs 63±10 yrs). Incidence of viable myocardium was 69% in females and 74% in males (p = NS). Incidence of viable myocardium in patients with and without different clinical characteristics is shown below: Clinical Characteristic Present Absent p value Chest pain 82*69*.05 Heart failure 74*73*.8 Prior infarction 73*72*.9 Beta blocter use 71*73*.3 Q wave on EKG 69*75*.3*% patients with viable myocardium by DE Baseline left ventricular ejection fraction was similar in patients with and without viable myocardium (26±6% vs 25±6%). Abnormal rest WM was present in 634 vascular regions. There was DO difference in percent vessel stenosis between regions with and without viability by DE (72±25% vs 71±28%, p = .2). Conclusions: Presence or absence of myocardial viability during DE cannot be determined from clinical data and requires additional testing.