Myocardial viability assessment: comparison between resting two dimensional visual assessment of dobutamine stress echocardiography and strain rate imaging

Patients with ischemic left ventricular dysfunction are increasingly referred for the assessment of myocardial viability. The issue of identifying dysfunctional but viable myocardium has crucial clinical importance, since revascularization increases survival only in patients with viable myocardial tissue. The aim of this study was to compare resting two-dimensional visual assessment of myocardial viability with dobutamine stress echocardiography and strain rate imaging. In this cross-sectional study, thirty-two consecutive patients [age: 55.3 +/- 22.7, 4 females] with ischemic left ventricular dysfunction were referred for myocardial viability assessment. Viability was evaluated using resting two-dimensional echocardiograms, dobutamine stress echocardiography and strain rate imaging. Viability was defined by the absence of brightness and thinning [<6 mm thickness] in akinetic segments, improvement by at least one grade or a biphasic response during dobutamine stress echocardiography or an increase in the peak systolic strain rate [more than -0.23 1/s]. A total of 254 segments were studied. Seventy- nine segments by dobutamine stress echocardiography, 70 segments by two-dimensional visual assessment, and 63 segments by strain rate were classified as non-viable [P< 0.001]. There was an almost perfect agreement among these diagnostic methods. Two-dimensional visual assessment with measurement of wall thickness is simple and practical methods for viability assessment, with almost perfect agreement with dobutamine stress echocardiography and strain rate imaging