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Dobutamine-Induced Contractile Reserve in Stunned, Hibernating, and Scarred Myocardium in Patients with Ischemic Cardiomyopathy

Arend F.L. Schinkel, MD, PhD1, Jeroen J. Bax, MD, PhD2, Ron van Domburg, PhD1, Abdou Elhendy, MD, PhD1, Roelf Valkema, MD, PhD3, Eleni C. Vourvouri, MD, PhD1, Fabiola B. Sozzi, MD, PhD1, Jos R.T.C. Roelandt, MD, PhD1 and Don Poldermans, MD, PhD1

1 Thoraxcenter, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
2 Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
3 Department of Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands



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  		FIGURE 1. Contractile reserve according to baseline wall motion (3 = severely hypokinetic, 4 = akinetic, 5 = dyskinetic) in all dysfunctional segments.

 


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  		FIGURE 2. Presence of contractile reserve according to resting 99mTc-tetrofosmin perfusion (0 = normal [100% >= uptake > 80%], 1 = mildly reduced [80% >= uptake > 50%], 2 = moderately reduced [50% >= uptake > 25%], 3 = severely reduced or absent [25% >= uptake >= 0%]).

 


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  		FIGURE 3. Segments with (white portions) and without (black portions) contractile reserve in response to dobutamine infusion in stunned, hibernating, and scarred myocardium. Contractile reserve was more frequently found in stunned than in hibernating myocardium (407 of 666 [61%] vs. 112 of 221 [51%], respectively; P < 0.01). Only 177 (14%) of 1,265 scarred segments exhibited contractile reserve; this percentage was considerably less than in stunned or hibernating myocardium (P < 0.001).

 


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  		FIGURE 4. Contractile reserve in nontransmural and transmural scar tissue. Contractile reserve was more frequently observed in nontransmural than in transmural scars (P < 0.001).

 




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