الفهرس 
Myocardial Ischemia, Stunning and Hypernation
Imaging protocols for assessing myocardial viabilityOnly 14 pages are availabe for public view
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Abstract
Non-invasive assessment utilized for the detection of viability include SPECT with Tc99m sestamibi and low dose dobutamine echocardiography. However detection of viable myocardium is imperfect, consequently, techniques that may improve detection of viable myocardium should be explored.
The aim of the study was to find if the patients with I.C.M with absence of myocardial viability by low dose dobutamine echocardiography still have a chance for functional recovery after coronary revascularization.
Thirty patients who were referred to El Demerdash hospital, for myocardial viability study before clinically indicated coronary angiography were recruited in this study with the following inclusion criteria: Left ventricular systolic dysfunction (LVEF < 40%) by transthoracic echocardiography (TTE), significant coronary artery stenosis (≥ 70% of diameter stenosis), coronary artery anatomy suitable for revascularization, discrepancy between the two techniques in viability results i.e negative viabilty by low dose DSE and positive viabilty by SPECT.
All the patients included were subjected to the following: History taking and clinical examination, 12 lead surface ECG, transthoracic echocardiography to assess left ventricular systolic functions (LVEF) and segmental wall motion abnormalities, rest Trimetazidine-Tc99m sestamibi SPECT to assess myocardial viability, low dose dobutamine echocardiography to assess myocardial viability, coronary revascularization (CABG or PCI) was done to patients with proved myocardial viability by either of the two techniques and finally three months post-procedural transthoracic echocardiography to assess functional recovery.
Patients were divided into two groups, patients with functional recovery after coronary revascularization group (A) and patients with no functional recovery after revascularization group (B), there were no statistically significance between two groups as regards mean age, sex, prevalence of HTN, smoking, dyslipidemia, family history, pre-revascularization SWMSI, pre-revascularization rest LV ejection fraction, grade of MR but there was a statistically significance as regards prevalence of DM, mean radiotracer uptake %, post revascularization SWMSI and LV ejection fraction.
By using multivariate logistic regression analysis, the mean radiotracer uptake % was the most powerful predictor of functional recovery after revascularization. A cut off value of (73.5%) was determined by ROC curve for functional recovery after revascularization.
As a conclusion patients with I.C.M. who are amenable to coronary revascularization with absence of viabilty detected by low dose dobutamine echocardiography should undergo rest trimetazidine-Tc99m sestamibi SPECT for viability study as they still have a chance for functional recovery after revascularization if mean radiotracer uptake % during rest trimetazidine-Tc99m sestamibi SPECT exceeds the cut off value (73.5%) determined by R.O.C. especially in the absence of D.M.