Predictive value of end-diastolic wall thickness for myocardial viability in patients with coronary artery disease with left ventricular dysfunction

ABSTRACT

early pathologic studies have demonstrated that myocardial thinning occurs in areas of myocardial necrosis, so preservation of wall thickness may be a sign of viability in coronary artery disease [CAD]. to assess the accuracy of end-diastolic wall thickness [EDWT], measured by resting echocardiography, as a marker of myocardial viability in patients with CAD and to compare it with dobutamine stress echocardiography [DSE] and thalium-201 scan [T-201 scan].20 patients with CAD associated with left ventricular [LV] dysfunction and c and idates for surgical revascularisation [SRV] were eligible for the study. Resting echo-Dopplar study, with special attention to EDWT measurement in each ischemic segment was performed before SRV together with DSE and T-201 scan. Another resting ech-Doppler study and T-201 scan were perforemed at a mean of 6 weeks after SRV. DSE showed that 112 out of 155 hypokinetic segments had improved after SRV and their resting EDWT was. 95 +/- . 2 vs. 6 +/- 1 cm in the 43 not-improved segments [P<.001] and 28 out of 66 akinetic segment had improved after SRV and their resting EDWT was. 8 +/- .l vs. 56 +/- .l cm in the 38 not-improved segments [P<.001]. T-201 scan showed that 107 out of 155 hypokinetic segments had improved after SRV and their EDWT was. 94 +/- .1 vs. 61 +/- 14 cm in 48 the not-improved segment [P<.01]; and 28 out of 66 akinetic segment had improved after SRV and their EDWT was. 83 +/- 1 vs 0.61 +/- 1 in the 38 not-improved segments [P<.001]. The sensitivity of EDWT >/= 7 cm for prediction of vialility in hypokinetic segments was 94% vs 100% by T-201 scan and 96% by DSE; and was 96% in akinetic segments vs 93% by T-201 scan and DSE. The specificity of EDWT in hypokinetic segments was 48% vs 22% by T-201 and 52% by DSE; and was 86% in akinetic segments vs 61% by T-201 and 95% by DSE. The positive predictive value of EDWT in hypokinetic segments was 75% vs 77% by T-201 scan and 84% by DSE, and was 58% in akinetic segments vs 64% by T-201 scan and 96% by DSE. The negative predictive value of EDWT was 85% in hypokinetic segments vs 100% by T-201 scan and 82% by DSE; and was 92% in.akinetic segments vs 92% by T-201 scan and 95% by DSE. Wall motion scor index decreased significantly from 1.8 +/- . 26 before SRV to 1.4 +/- 2 after SRV and 1.3 +/- 4 on DSE [P<.001]. Ejection fraction increased significantly from 3 7 +/- 11.9 before SRV to 44 +/- 11.1 after SRV and 45 +/- 11.3 on DSE [P<.001]. we concluded that EDWT >/= 7 cm is measured by resting echocardiography is a simple and reproducible marker ofmyocardial vilability. Its accuracy is comparable to that of DSE and thallium 201-scan