Dobutamine Echocardiography in Myocardial Hibernation

Afridi, Imran; Kleiman, Neal S.; Raizner, Albert E.; Zoghbi, William A.

doi:10.1161/01.cir.91.3.663

Cited by 460 publications

(86 citation statements)

References 26 publications

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“…Images at baseline, 5, and 7.5 g/kg/min and peak dobutamine were digitized online in a quadscreen format to provide optimal assessment of viability. 17 The response of dysfunctional segments to dobutamine was classified as biphasic (improvement at a low dose with worsening at a high dose), worsening, no change, and sustained improvement (increased thickening without worsening later on). Any response during dobutamine echocardiography was considered indicative of viability.…”

Section: Dobutamine Echocardiographymentioning

confidence: 99%

Evidence for an Active Inflammatory Process in the Hibernating Human Myocardium

Frangogiannis

Shimoni

Chang

et al. 2002

The American Journal of Pathology

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Myocardial hibernation refers to a state of prolonged impairment of left ventricular function in the presence of coronary artery disease, which may be reversed by revascularization. In this study we present evidence for a local inflammatory reaction in hibernating myocardial segments from patients undergoing coronary revascularization. We obtained transmural myocardial biopsies guided by transesophageal echocardiography from patients with ischemic ventricular dysfunction undergoing bypass surgery. Among the 28 biopsied segments included in the study, 23 showed evidence of systolic dysfunction. The majority of dysfunctional segments (85.7%) were viable ( 201 Tl uptake > 60%). The samples were stained with markers for mast cells, mature resident macrophages, and the monoclonal antibody Mac387 that labels newly recruited myeloid cells. Dysfunctional segments showed more extensive fibrosis and higher macrophage density than normal segments. Among the 23 dysfunctional segments, 12 recovered function as assessed with echocardiograms 3 months after revascularization. Segments with postoperative functional recovery had comparable macrophage and mast cell density with those showing persistent dysfunction. However, biopsied segments that subsequently recovered function contained significantly higher numbers of newly recruited Mac387-positive leukocytes (18.7 ؎ 3.1 cells/mm 2 , n ‫؍‬ 12 versus 8.6 ؎ 0.9 cells/mm 2 , n ‫؍‬ 11; P ‫؍‬ 0.009). In addition, monocyte chemotactic protein-1, a potent mononuclear cell chemoattractant, was predominantly expressed in segments with recovery of function. Myocardial hibernation is associated with an inflammatory response leading to active leukocyte recruitment. Dysfunctional myocardial segments that show an active inflammatory reaction have a greater potential for recovery of function after revascularization. We pos-

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Section: Dobutamine Echocardiographymentioning

confidence: 99%

Evidence for an Active Inflammatory Process in the Hibernating Human Myocardium

Frangogiannis

Shimoni

Chang

et al. 2002

The American Journal of Pathology

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“…Contractile reserve was diagnosed if global LV ejection fraction improved by N 10% on stress echocardiography, as compared with baseline values [13][14][15]. Segments were considered viable if they showed an improvement ≥ 1 point in the wall motion score index during stress echocardiography without further worsening [16,17]. A delta in wall motion score index ≥ 0.40 [17], and an improvement in ≥ 25% of severely dysfunctional segments [18] were evaluated as measures of viability.…”

Section: Methodsmentioning

confidence: 99%

“…Segments were considered viable if they showed an improvement ≥ 1 point in the wall motion score index during stress echocardiography without further worsening [16,17]. A delta in wall motion score index ≥ 0.40 [17], and an improvement in ≥ 25% of severely dysfunctional segments [18] were evaluated as measures of viability.…”

Section: Methodsmentioning

confidence: 99%

“…To this end, dobutamine echocardiography has become the most widely used test because it has a good predictive value for functional recovery after revascularisation [3,4]. Sensitivity and specificity of the test, however, are sometimes reduced by induction of myocardial ischaemia and by the occurrence of side effects during drug infusion [5,6].…”

Section: Background and Aimmentioning

confidence: 99%

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Levosimendan allows detection of contractile reserve in patients with chronic ischaemic left ventricular dysfunction and non‐diagnostic dobutamine echocardiography

Cianfrocca

Pelliccia

Auriti

et al. 2007

European J of Heart Fail

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Background: Dobutamine echocardiography is commonly used to detect contractile reserve in ischaemic left ventricular (LV) systolic dysfunction, although its sensitivity and specificity are not optimal. We tested the hypothesis that echocardiography with levosimendan could identify contractile reserve in patients with a non-diagnostic dobutamine test. Methods: Twenty-two patients with LV ejection fraction b 40% and non-diagnostic dobutamine echocardiography underwent levosimendan challenge (24 μg/kg in 10 min) prior to coronary angioplasty or surgery. Results: Contractile reserve was identified by levosimendan in 10 patients (Gr. A) but was not seen in 12 patients (Gr. B). With levosimendan, LV ejection fraction increased and wall motion score index decreased significantly in Gr. A, but only slightly in Gr. B. Similarly, mean mitral annular plane excursion and peak systolic mitral annular motion velocity increased significantly in Gr. A only. Six months after revascularisation, contractile reserve was seen in 8/10 Gr. A patients but in only 2/12 Gr. B patients (80% vs 17%, p = 0.011). LV ejection fraction, wall motion score index, mean mitral annular plane excursion and peak systolic mitral annular motion velocity were significantly higher in Gr. A than in Gr. B. Conclusion: Levosimendan echocardiography can identify contractile reserve in a sizeable proportion of patients with chronic ischaemic LV dysfunction and a non-diagnostic dobutamine test.

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“…If administration of dobutamine improves wall motion, function will improve after revascularisation. 31 Left ventricular dysfunction has an adverse prognosis. Therefore, attempts to protect the hibernating or recurringly stunned myocardium may be beneficial.…”

Section: Myocardial Hibernationmentioning

confidence: 99%

The myocardium

Foëx¹,

Howell²

1997

Can J Anaesth

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The myocardium O VER the past few years a number of new and important concepts relating to the heart and the coronary circulation have evolved. They are relevant to the practice of anaesthesia and intensive care, and will be discussed under the headings of local vs humoral and hormonal control of the coronary circulation, effects ofischaemia on cardiac fimction, including myocardial stunning, hibernation and preconditioning and, finally, coronary steal. Control of the coronary circulationThe normal control of coronary blood flow is through alterations in the resistance of intramyocardial arterioles. Increased breakdown of ATP results in increased concentrations of adenosine, a potent endogenous vascular smooth muscle relaxant. This local mechanism allows coronary blood flow to be adjusted to the oxygen requirements.L2 Other mediators are also involved in the control of the coronary circulation. These include nitric oxide, prostacyclin, thromboxane and endothelins, s-s These mediators are synthesised and released by the endothelium. In the presence of atheroma, the endothelial function in large arteries is disrupted. Imbalances between mediators predispose to inappropriate vasoconstriction, platelet aggregation and thrombosis, 6 Endothelins may have a particular role in such events as they are among the most potent vasoconstrictors. 7Neurogenic control Activation of the sympathetic nervous system causes marked changes in coronary blood flow. These changes are mediated in part by changes in metabolic demand. However, large and small coronary arteries are subject to control by alpha-and beta-adrenergic mechanisms. Alpha l-and alphaz-adrenoceptors elicit constriction, while beta 1-and beta2-adrenoceptors elicit dilatation, of large coronary arteries, s Alphaadrenergic constriction competes with metabolic vasodilatation. This competition is attenuated by the endogenous production of adenosine. However, adenosine modulates alpha z-and not alphai-adrenoceptor mediated vasoconstriction. 9Activation of the parasympathetic nervous system usually causes a reduction in coronary blood flow because bradycardia and hypotension reduce oxygen demand. However, if the bradycardia resulting from vagal stimulation is prevented by pacing, coronary blood flow increases uniformly across the left ventricular wall in response to vagal stimulation. By contrast, acetylcholine preferentially vasodilates the vessels of the subendocardium. 1~While the role of the autonomic nervous system in the control of the coronary circulation has long been underestimated, many studies of patients with variant angina suggest that there is local nonspecific supersensitivity to vasoconstrictors. 11 Alpha-adrenergic constriction of coronary resistance vessels may result in the precipitation ofpost-stenotic myocardial ischaemia both in experimental models and in patients with effort angina. In contrast, the adverse effects of beta-adrenergic stimulation are a consequence of the tachycardia and the tachycardia-related redistribution of coronary blood flow, as t...

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Dobutamine Echocardiography in Myocardial Hibernation

Cited by 460 publications

References 26 publications

Evidence for an Active Inflammatory Process in the Hibernating Human Myocardium

Evidence for an Active Inflammatory Process in the Hibernating Human Myocardium

Levosimendan allows detection of contractile reserve in patients with chronic ischaemic left ventricular dysfunction and non‐diagnostic dobutamine echocardiography

The myocardium

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