Cor Vasa 2003, 44(7-8):366-375

Evaluation of myocardial viability using acoustic densitometry in patients with chronic coronary heart disease

Roman Panovský^1,*, Jaroslav Meluzín¹, Vladimír Kincl¹, Blanka Fischerová¹, Jan Černý², František Štětka²

¹ I. interní-kardioangiologická klinika, Fakultní nemocnice u sv. Anny

² Centrum kardiovaskulární a transplantační chirurgie, Brno, Česká republika

Aim:
Our study was designed to establish whether or not measurement of the amplitude of cyclic variation of integrated backscatter (CVIB) can identify a viable myocardium from irreversible damage in patients with chronic coronary heart disease (CHD) prior to elective myocardial revascularization.

Method:
Seventy patients with chronic CHD and dysfunctional myocardial segments were examined by acoustic densitometry before a scheduled myocardial revascularization procedure. Fifty-four patients had revascularization of at least one artery supplying the dysfunctional vascular bed. These patients had, at a mean interval of 3 months after surgery or intervention, follow-up echocardiography to assess the function of revascularized, originally dyskinetic segments. The finding of this examination was taken as a reference for evaluating the applicability of acoustic densitometry to estimate myocardial viability. A 16-segment model of the left ventricle was used, acoustic densitometry was assessed using examinations in the parasternal long axis, parasternal short axis at level of mitral valve papillary muscle, and in apical four-chamber and two-chamber projections.
The peak CVIB amplitude of each segment was assessed. The method of receiver operating characteristic curve (ROC) was used to define the optimal cut off value for identifying viable from irreversibly damaged myocardium.

Results:
The cut off CVIB values for the anteroseptal segments, posterior wall, septum, lateral wall, inferior wall, anterior wall and apex are 4.1; 4.3; 4.4; 4.2; 4.5; 4.0, and 4.2 dB (decibels), respectively. The sensitivity of densitometry for obtaining evidence of a viable myocardium when using these limit values is 90.8%, specificity 81.3%, positive predictive value 87.4% and negative predictive value 86.1%.

Conclusion:
The values of CVIB amplitude, derived from dysfunctional myocardial segments of patients with chronic CHD, differ significantly depending on whether segments with viable or irreversibly damaged myocardium are involved. Limit CVIB values for diagnosing myocardial viability for individual left ventricular walls are within the range of 4.0-4.5 dB. When using these limit values, the sensitivity and specificity of CVIB are 90.8% and 81.3%, respectively.

Keywords: Coronary heart disease; Echocardiography; Viable myocardium; Acoustic densitometry

Published: July 1, 2003  Show citation