Assessment of viable myocardium by dobutamine transesophageal echocardiography and comparison with fluorine-18 fluorodeoxyglucose positron emission tomography

J Am Coll Cardiol. 1994 Aug;24(2):343-53. doi: 10.1016/0735-1097(94)90286-0.


Objectives: The aim of this study was to assess whether dobutamine transesophageal echocardiography can identify viable myocardium in patients with chronic myocardial infarction.

Background: Experimental and clinical studies have shown that dobutamine can recruit a contraction reserve in postischemic viable but akinetic segments, indicating that dobutamine-induced functional recovery is a potential ultrasound marker of myocardial viability.

Methods: Forty patients underwent rest and dobutamine transesophageal echocardiography (dobutamine 5, 10 and 20 micrograms/kg body weight per min) and fluorine-18 (F-18) fluorodeoxyglucose positron emission tomography at rest. Three representative short-axis tomograms and a transverse four-chamber-view were used for wall motion and F-18 fluorodeoxyglucose-uptake analysis in corresponding myocardial regions. A basally asynergic segment was considered viable by transesophageal echocardiography if dobutamine-induced systolic wall motion could be observed. Viability by positron emission tomography was defined as F-18 fluorodeoxyglucose uptake > or = 50% of the maximal uptake in a region with normal wall motion by left ventriculography.

Results: Functional recovery within the infarct region was found in 21 (53%) of 40 patients during dobutamine infusion. Infarct region-related viability by F-18 fluorodeoxyglucose uptake was diagnosed in 25 (63%) of 40 patients, yielding a diagnostic agreement between both techniques in 90% of patients. In 210 (89%) of 235 akinetic segments at rest, data on myocardial viability were concordant by the two techniques. The positive and negative predictive accuracy of dobutamine transesophageal echocardiography for viability defined by F-18 fluorodeoxyglucose uptake was 81% and 97%, respectively. Such uptake was significantly different (p < 0.001) between segments remaining akinetic (mean +/- SD 45 +/- 9%) during dobutamine infusion and segments with a dobutamine-induced contraction reserve (68 +/- 11%).

Conclusions: Dobutamine transesophageal echocardiography provides a promising low cost and widely available approach to unmask myocardial viability in patients with chronic myocardial infarction, and results compare favorably with those of F-18 fluorodeoxyglucose positron emission tomography.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Deoxyglucose / analogs & derivatives*
  • Dobutamine*
  • Echocardiography, Transesophageal*
  • Evaluation Studies as Topic
  • Female
  • Fluorodeoxyglucose F18
  • Heart / diagnostic imaging
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnostic imaging*
  • Tomography, Emission-Computed*


  • Fluorodeoxyglucose F18
  • Dobutamine
  • Deoxyglucose