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Dobutamine Stress Echocardiography for assessment of myocardial viability: accuracy and impact of beta-blockade on the results
Session:
Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker:
Pedro Teixeira Carvalho
Congress:
CPC 2021
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.3 Coronary Artery Disease – Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Pedro Teixeira Carvalho; Adriana Pacheco; Diana Carvalho; Lisa Ferraz; Jose Luis Martins; Jesus Viana; Ana Faustino; Manuela Vieira; Ana Briosa Neves
Abstract
<p style="text-align:start"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:medium"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="color:black">Background</span></span></strong></span></span></span></p> <p style="text-align:start"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:medium"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">Patients with ischaemic left ventricular (LV) dysfunction are often referred for dobutamine stress echocardiography (DSE) for the assessment of myocardial viability. These patients are usually receiving treatment with ß-blockers (ßB), either due to angina or heart failure. Although withdrawal of ßB is common practise before a diagnostic DSE test, that is often not the case for viability assessment and there is limited information as to whether the accuracy of the test is affected by concurrent ß-blockade.</span></span></span></span></span></p> <p style="text-align:start"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:medium"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">The purpose of this study, therefore, was to assess the accuracy of DSE to detect myocardial viability in patients with ischaemic LV dysfunction and to determine whether beta-blockade influences the results.</span></span></span></span></span></p> <p style="text-align:start"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:medium"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="color:black">Methods</span></span></strong></span></span></span></p> <p style="text-align:start"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:medium"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">This was a retrospective study including consecutive patients who underwent DSE prior to revascularization. Key inclusion criteria were obstructive coronary artery disease </span></span></span></span></span><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:medium"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">causing ≥3 dysfunctional segments in the baseline resting evaluation. All patients underwent resting echocardiography (TTE) >3 months after revascularization. A wall motion score was assigned to each segment for each DSE stage, using a standard 16 segment model of the LV. The segments were analysed individually for viability and were compared with the resting TTE after revascularization. Non-revascularized segments were excluded from the analysis.</span></span></span></span></span></p> <p style="text-align:start"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:medium"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="color:black">Results</span></span></strong></span></span></span></p> <p style="text-align:start"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:medium"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">Of the 25 patients included in the study, 84% were male and median age was 72 years (IQ 64-76). At least 44% of patients had documented prior myocardial infarction. Median basal LV ejection fraction was 44% (IQ 35-49). At the time of DSE, 16% of patients were not taking </span></span><span style="font-size:11pt"><span style="color:black">ßB, 40% were on low-dose ßB (25% of max dose) and 44% were on high-dose ßB (≥50% of max dose). Coronary artery bypass grafting was performed in 40% of patients, the remainder underwent PCI. Revascularization was complete in 64% of patients. Median LVEF after revascularization was 46% (IQ 37-53). </span></span></span></span></span></p> <p style="text-align:start"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:medium"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">Of the 400 segments analysed, 232 (58%) were dysfunctional at rest, of which 206 (89%) had the corresponding coronary artery revascularized and were included in the analysis. There was an improvement of resting function on DSE in 78 (38%) of these segments. After revascularization, 134 of the dysfunctional segments (60%) recovered resting function. Accuracy for detecting viable segments was 64%, sensitivity was 52% and specificity was 83% (AUC 0.673; CI 0.599 – 0.747).</span></span></span></span></span></p> <p style="text-align:start"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:medium"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">There was an inverse relation of the dose of </span></span><span style="font-size:11pt"><span style="color:black">ßB intake with exam sensitivity, as increasing doses were associated with inferior sensitivity (no intake: 77%; low dose: 57%; high dose: 40%; <em>p=.001</em>).</span></span></span></span></span></p> <p style="text-align:start"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:medium"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="color:black">Conclusion</span></span></strong></span></span></span></p> <p style="text-align:start"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:medium"><span style="color:#000000"><span style="font-size:11pt"><span style="color:black">This study suggests that ßB intake significantly reduces DSE sensitivity for the detection of viable myocardium in patients with ischaemic left ventricular dysfunction. There is a rationale for ßB withdrawal before this exam. Further prospective data will assess this hypothesis.</span></span></span></span></span></p>
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