ssessment of myocardial viability (MV) is importantto predict functional recovery and future cardiac events in patients with acute myocardial infarction (AMI). 1,2 Dobutamine stress echocardiography (DSE), in particular using low-dose dobutamine, is an excellent method for diagnosing MV and predicting the recovery of left ventricular dysfunction after MI, as well as in those patients who have undergone after revascularization for chronic ischemic heart disease. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] 123 I-labelled 15-iodophenyl-3-R, S-methyl pentadecanoic acid (BMIPP) reflects the fatty acid utilization of the myocardium and is used with single-photon emission computed tomography (SPECT) for energy metabolism studies. 19 When myocardial ischemia occurs, there is prolonged impaired uptake of BMIPP. [19][20][21] Previous studies have demonstrated that concordant defects of perfusion and BMIPP scans represent scarred or non-viable tissue, a lower BMIPP uptake relative to perfusion (perfusion -BMIPP mismatch) indicates metabolically damaged but viable myocardium, and equivalently normal perfusion and BMIPP uptake represents normal or completely salvaged myocardium. 19,20,22,23 Furthermore, a perfusion -BMIPP mismatch is a good predictor of functional recovery after myocardial infarction. 23 Thus MV can be estimated by both DSE and dual-isotope simultaneous acquisition of myocardial perfusion with BMIPP. These methods, however, have their own merits and limitations, and have rarely been directly compared in the same patient following AMI to assess for their ability to diagnose MV and predict long-term functional recovery. 23 Methods Study PatientsThe study prospectively enrolled 35 consecutive patients (26 men, 9 women; mean age, 63±10 years) admitted with AMI between January 2000 and March 2001 who underwent both DSE and dual SPECT in the National Kyushu Medical Center. Diagnosis of AMI was based on typical chest pain lasting longer than 30 min, ST segment elevation Discordance between the 123 I-labelled 15-iodophenyl-3-R, S-methyl pentadecanoic acid (BMIPP) and 201 Tl findings may indicate myocardial viability (MV). This study compared dobutamine stress echocardiography (DSE) and single-photon emission computed tomography (SPECT) using the dual tracers for assessment of MV and prediction of functional recovery after acute myocardial infarction (AMI). DSE and dual SPECT were studied in 35 patients after AMI, of whom 28 underwent percutaneous coronary intervention in the acute stage. Dual SPECT was performed to compare the defect score of BMIPP and 201 Tl. The left ventricular wall motion score (WMS) was estimated during DSE and 6 months later to assess functional recovery of the infarct area. The rate of agreement of MV between dual SPECT and DSE was 89% (p<0.01), and the sensitivity and specificity of DSE for dual SPECT in MV assessment was 86% and 93%, respectively. The positive and negative predictive values for functional recovery by dual SPECT were 76% and 67%, respectively, and by DSE were 9...

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