Acurácia da ecocardiografia com estudo da perfusão miocárdica na avaliação de viabilidade em pacientes com disfunção ventricular esquerda crônica submetidos à revascularização / Real-time perfusion echocardiography accuracy for detecting viability in chronic left ventricular dysfunction undergoing myocardial revascularization

AUTOR(ES)

Daniela Ribeiro Aleixo Fernandes

DATA DE PUBLICAÇÃO

2009

RESUMO

BACKGROUND: Real-time perfusion echocardiography (RTPE) is an emerging modality for assessing myocardial perfusion and allows noninvasive quantification of regional myocardial blood flow. Little is known about the accuracy of the RTPE for the assessment of myocardial viability and the possibility of prediction of quality of life improvement after myocardial revascularization. METHODS: Twenty four patients with coronary artery disease and ventricular dysfunction underwent RTPE and answered Minnesota Quality of Life Questionnaire before and repeated after myocardial bypass coronary surgery. RTPE was performed using continuous PESDA or Definity intravenous infusion with power modulation image. Regional function recovery after surgical procedure was considered the standard reference (hibernating myocardial). Qualitatively, viability was defined as presence of homogeneous opacification in at least one myocardial segment in a rest revascularized territory, according coronary distribution. For myocardial blood flow evaluation, the left ventricle was divided into 17 segments, and indexes of myocardial blood volume (A), blood flow velocity (), and myocardial blood flow (Ax) were obtained for each myocardial segment at rest condition. All revascularized territories were analyzed. RESULTS: Hibernating myocardial was observed in 77% of RTPE viable territories and in 44% in non-viable ones (p=0.03). Sensitivity, specificity, predictive positive and negative values of qualitative RTPE viability detecting were 74%, 60%, 77% and 56%, respectively. A combined analysis (contractile reserve and/or myocardial perfusion) provided sensitivity, specificity, predictive positive and negative values of 89%, 40%, 73% e 67%, respectively. The sensitivity, specificity, predictive positive and negative values of Ax1.76 for recovery of function were 91%, 50%, 75% and 78%, respectively, with an accuracy of 76%. Quality of life score improved from 36.4 (29.1-43.6) to 18.1 (12.8-23.4; p =0.001). However, there was no statistical correlation with RTPE. CONCLUSION: In conclusion, RTPE provides good accuracy of detecting hibernating myocardial in patients with coronary artery disease and ventricular dysfunction. Nevertheless, it couldnt predict the quality of life improvement after myocardial revascularization

ASSUNTO(S)

coronary heart disease doenças das coronárias coronary bypass surgery echocardiography contrast echocardiography ecocardiografia de contraste ecocardiografia revascularização miocárdica

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