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Sequential ²⁰¹Tl Imaging and Dobutamine Echocardiography to Enhance Accuracy of Predicting Improved Left Ventricular Ejection Fraction After Revascularization

¹ Department of Cardiology, University Hospital Leiden, Leiden, The Netherlands
² Department of Molecular and Medical Pharmacology (Nuclear Medicine) and Radiological Sciences, UCLA School of Medicine, Los Angeles, California
³ Department of Cardiology, ThoraxCenter Rotterdam, Rotterdam, The Netherlands
⁴ Department of Clinical Epidemiology/Statistics, ThoraxCenter Rotterdam, Rotterdam, The Netherlands

View larger version (25K): [in a new window]   FIGURE 1. Individual LVEFs before and after revascularization (rev) in patients without 5% improvement of LVEF (A) and with 5% improvement of LVEF (B).

View larger version (18K): [in a new window]   FIGURE 2. ROC curve analysis of 201Tl data shows that cutoff value of 6 dysfunctional but viable segments yielded highest sensitivity and specificity for predicting improved LVEF after revascularization.

View larger version (17K): [in a new window]   FIGURE 3. ROC curve analysis of dobutamine echocardiographic data shows that cutoff value of 4 dysfunctional but viable segments yielded highest sensitivity and specificity for predicting improved LVEF after revascularization.

View larger version (26K): [in a new window]   FIGURE 4. Flow chart of characterization (and outcome) of patients according to strategy 1 (201Tl was performed as initial test, and DE was performed as additional test on patients with intermediate likelihood of viability on 201Tl). nr. = number; segs = segments.

View larger version (37K): [in a new window]   FIGURE 5. Bar graph shows sensitivities and specificities of 201Tl, DE, and sequential strategies (strategy 1: 201Tl was initial test, and DE was additional test; strategy 2: DE was initial test, and 201Tl was additional test) for predicting improved LVEF after revascularization. Sens = sensitivity; spec = specificity; strat = strategy.

View larger version (26K): [in a new window]   FIGURE 6. Flow chart of characterization (and outcome) of patients according to strategy 2 (DE was performed as initial test, and 201Tl was performed as additional test on patients with intermediate likelihood of viability on DE). nr. = number; segs = segments.