Knowledge of Perfusion and Contractile Reserve Improves the Predictive Value of Recovery of Regional Myocardial Function Postrevascularization

Meza, Mario F.; Ramee, Stephen R.; Collins, Tyrone J.; Stapleton, Dwight D.; Milani, Richard V.; Murgo, Joseph P.; Cheirif, Jorge

doi:10.1161/01.cir.96.10.3459

Cited by 59 publications

(28 citation statements)

References 29 publications

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“…1,7 Contrast echocardiography is increasingly referred to as a technique that could potentially allow quantification 4 -6 or at least imaging of myocardial perfusion. 2,3,8,16,17 This goal, however, still remains a great challenge.…”

Section: Discussionmentioning

confidence: 99%

Combined Assessment of Myocardial Perfusion and Regional Left Ventricular Function by Analysis of Contrast-Enhanced Power Modulation Images

et al. 2001

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Background-Echocardiographic contrast media have been used to assess myocardial perfusion and to enhance endocardial definition for improved assessment of left ventricular (LV) function. These methodologies, however, have been qualitative or have required extensive offline image analysis. Power modulation is a recently developed imaging technique that provides selective enhancement of microbubble-generated reflections. Our goal was to test the feasibility of using power modulation for combined quantitative assessment of myocardial perfusion and regional LV function in an animal model of acute ischemia. Methods and Results-Coronary balloon occlusions were performed in 18 anesthetized pigs. Transthoracic power modulation images (Agilent 5500) were obtained during continuous intravenous infusion of the contrast agent Definity (DuPont) at baseline and during brief coronary occlusion and reperfusion and were analyzed with custom software. At each phase, myocardial perfusion was assessed by calculation, in 6 myocardial regions of interest, of mean pixel intensity and the rate of contrast replenishment after high-power ultrasound impulses. LV function was assessed by calculation of regional fractional area change from semiautomatically detected endocardial borders. All ischemic episodes caused detectable and reversible changes in perfusion and function. Perfusion defects, validated with fluorescent microspheres, were visualized in real time and confirmed by a significant decrease in pixel intensity in the left anterior descending coronary artery territory after balloon inflation and reduced rate of contrast replenishment. Fractional area change decreased significantly in ischemic segments and was restored with reperfusion. Conclusions-Power modulation allows simultaneous online assessment of myocardial perfusion and regional LV wall motion, which may improve the echocardiographic diagnosis of myocardial ischemia.

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Section: Discussionmentioning

confidence: 99%

Combined Assessment of Myocardial Perfusion and Regional Left Ventricular Function by Analysis of Contrast-Enhanced Power Modulation Images

et al. 2001

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“…Subsequent microbubble replenishment is observed over the next 10 to 15 cardiac cycles and reflects myocardial blood velocity. 28,29 Segments are classified as viable if homogeneous contrast intensity is present, whereas the absence of contrast enhancement reflects nonviable myocardium in which necrosis of myocardial cells has resulted in obstruction and collapse of the microcirculation. 30 Myocardial contrast echocardiography has a high sensitivity for predicting functional recovery after revascularization but low specificity compared with DSE.…”

Section: Assessment Of Viabilitymentioning

confidence: 99%

Stunning, Hibernation, and Assessment of Myocardial Viability

2008

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“…Recent studies with noninvasive assessments such as SPECT, positron emission tomography and low-dose dobutamine stress echocardiography have reported successful prediction of recovery in LV function after coronary revascularization. 12,[18][19][20][21][22] Using segmental systems, most of those studies focused on regional LV function, [18][19][20][21][22][23] not on global LV function, which is more relevant in the clinical setting. In the present study, done in patients with severe LV dysfunction, a significant recovery in global LV function, documented by an increase in the LVEF of 15-24% (95% CI), was demonstrated in association with marked improvement in heart failure symptoms and NYHA functional class.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7][8]12,[18][19][20][21][22]26 These methods are grouped as either stimulants of inotropic reserve, of which low-dose dobutamine stress echocardiography is most widely used, or radioactive tracers, which are used in SPECT or positron emission tomography. Even head-to-head comparison studies between the former and the latter were conducted recently.…”

Section: Discussionmentioning

confidence: 99%

“…Even head-to-head comparison studies between the former and the latter were conducted recently. 12,[20][21][22] These studies, however, rarely mention the clinical reality that many institutions do not have either expensive modalities, such as positron emission tomography, or qualified specialists, particularly for stress echocardiography. 29 In contrast, the method presented in the present study used 201 Tl SPECT perfusion imaging, which is most frequently used in institutions and with which most clinicians have more experience.…”

Section: Discussionmentioning

confidence: 99%

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Functional Recovery After Coronary Artery Bypass Grafting in Patients With Severe Left Ventricular Dysfunction and Preserved Myocardial Viability in the Left Anterior Descending Arterial Territory as Assessed by Thallium-201 Myocardial Perfusion Imaging

et al. 1999

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he prognosis of patients with coronary artery disease and severe left ventricular (LV) dysfunction is poor, unless significant functional recovery is gained with coronary revascularization to viable myocardium. [1][2][3][4][5][6][7][8] The purpose of the present study was to evaluate the clinical significance of myocardial viability in the territory supplied by the left anterior descending artery (LAD) in patients with severe LV dysfunction (ejection fraction (EF) ≤35%) who underwent coronary artery bypass grafting (CABG), because the prognostic and procedural significance of CABG to the LAD coronary artery was underscored recently. 9-11 Methods Study PatientsOne hundred consecutive patients, all who demonstrated of having myocardial viability in the LAD territory and who undergone CABG (66 men, 34 women, aged 42-85 years [mean, 66]) were studied retrospectively. Previous myocardial infarction and CABG had occurred in 66 and 3 patients, respectively. Left main coronary artery disease was found in 31 patients, 3-vessel disease in 44, 2-vessel disease in 23, and 1-vessel disease in 2. Written informed consent was obtained from all of the patients. EchocardiographyEchocardiographms were performed using a Toshiba SSH-65A (Tokyo, Japan) or an Aloka SSD-710 (Tokyo, Japan) with 2.5-3.75 MHz transducers. A complete Mmode and 2-dimensional study were performed and recorded on video tape for subsequent analysis. LV segmental wall motion abnormality and systolic wall thickJpn Circ J 1999; 63: 752 -758 (Received May 6, 1999; revised manuscript received June 24, 1999; accepted July 5, 1999 To evaluate the functional recovery after coronary bypass surgery in patients with severe left ventricular (LV) dysfunction (ejection fraction (EF) ≤35%), 100 consecutive patients with viable myocardium in the territory supplied by the left anterior descending artery (LAD) underwent coronary bypass grafting. In addition, cardiac catheterization and single-photon emission computed tomography (SPECT) perfusion imaging with thallium-201 were repeated 1-year postoperatively. Although 12 patients with severe LV dysfunction were preoperatively in a worse New York Heart Association functional class (3.1±0.7 vs 2.4±0.8; p<0.01), had a higher incidence of heart failure (10/12 vs 14/88; p<0.001) and had a worse LVEF (29±5 vs 61±14%; p<0.001) compared with 88 patients without severe LV dysfunction, the operative mortality was similar in the 2 groups (1/12 vs 2/88; p=NS). The postoperative NYHA functional class in the patients with severe LV dysfunction was similar to that in the patients without such dysfunction (1.6±0.7 vs 1.3±0.6; p=NS). In addition, the 1-year postoperative study revealed a significant improvement in the thallium defect score in both the LAD territory (1.7±1.2 to 0.7±1.0, p=0.01) and all the territories (5.2±2.2 to 3.2±1.9, p=0.002) in patients with severe LV dysfunction, whereas no improvement in defect score was found in either of these territories in those without severe LV dysfunction (LAD: 0.6±1.4 to 0.4±1.2, p=NS; All: 1.9±...

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Knowledge of Perfusion and Contractile Reserve Improves the Predictive Value of Recovery of Regional Myocardial Function Postrevascularization

Abstract: The prediction of functional recovery post-revascularization can be enhanced by combining MCE and DE.

Cited by 59 publications

References 29 publications

Combined Assessment of Myocardial Perfusion and Regional Left Ventricular Function by Analysis of Contrast-Enhanced Power Modulation Images

Combined Assessment of Myocardial Perfusion and Regional Left Ventricular Function by Analysis of Contrast-Enhanced Power Modulation Images

Stunning, Hibernation, and Assessment of Myocardial Viability

Functional Recovery After Coronary Artery Bypass Grafting in Patients With Severe Left Ventricular Dysfunction and Preserved Myocardial Viability in the Left Anterior Descending Arterial Territory as Assessed by Thallium-201 Myocardial Perfusion Imaging

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