Abstract

GONZALEZ MORENO, JUAN BAUTISTA et al. Utilidad clínica de ecodobutamina a bajas dosis para la detección de viabilidad miocárdica regional antes y después de la revascularización quirúrgica. Rev.Urug.Cardiol. [online]. 2005, vol.20, n.1, pp.05-15. ISSN 1688-0420.

Seventy-eight consecutive patients (mean 63±10 years, 79,5% men) with a story of myocardial infarction and indication of coronary by-pass surgery (CBC) were studied with low-dose dobutamine echocardiography before (ED1) and and at three months follow-up (ED2) to evaluate its clinical utility in the detection of viable myocardium. We determined the expected utilities of global patients (P n=67) and coronary territories (T n= 126) with the classic strategy: ED1 and results of the rest follow-up echocardiogram (EB2) and applying to it a complementary strategy which submitted false positives (FP) and false negatives (FN) to ED2 results. Assigned utilities in each node of the decision tree are: maximal (1,0), sub-maximal (0,75) and intermedium (0,50) using the folding method as mathematical model. Results: global P and T expected utilitities with the decision of performing an ED1 are 0,84 and 0,89 respectively for viability detection, 0,85 and 0,82 to confirm it and 0,83 and 0,82 to not confirm it respectively in EB2. The expected utilities with the decision of performing an ED2 to FP are 0,74 and 0,76 (viability was detected in 66% of P and in 58% of T) and 0,47 and 0,45 respectively, applied to FN. Conclusions: low-dose dobutamine echocardiography brings high clinical utility in finding viable or scar myocardium before CBC, and when discordant results are found in follow-up, in particular with FP.

Keywords : DOBUTAMINE ECHOCARDIOGRAPHY; VIABLE MYOCARDIUM; CLINICAL UTILITY.