Patients With Hibernating Myocardium Show Altered Left Ventricular Volumes and Shape, Which Revert After Revascularization

Carluccio, Erberto; Biagioli, Paolo; Alunni, Gianfranco; Murrone, Adriano; Giombolini, Claudio; Ragni, Temistocle; Marino, Paolo; Reboldi, Gianpaolo; Ambrosio, Giuseppe

doi:10.1016/j.jacc.2005.09.064

Cited by 116 publications

(80 citation statements)

References 38 publications

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“…18 Together with the small sample size, this relatively high rate of segmental recovery in the placebo group might have obscured a potential treatment effect.…”

Section: Interpretation Of Efficacy End Pointsmentioning

confidence: 99%

The Myoblast Autologous Grafting in Ischemic Cardiomyopathy (MAGIC) Trial

et al. 2008

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Background-Phase I clinical studies have demonstrated the feasibility of implanting autologous skeletal myoblasts in postinfarction scars. However, they have failed to determine whether this procedure was functionally effective and arrhythmogenic. Methods and Results-This multicenter, randomized, placebo-controlled, double-blind study included patients with left ventricular (LV) dysfunction (ejection fraction Յ35%), myocardial infarction, and indication for coronary surgery. Each patient received either cells grown from a skeletal muscle biopsy or a placebo solution injected in and around the scar. All patients received an implantable cardioverter-defibrillator. The primary efficacy end points were the 6-month changes in global and regional LV function assessed by echocardiography. The safety end points comprised a composite index of major cardiac adverse events and ventricular arrhythmias. Ninety-seven patients received myoblasts (400 or 800 million; nϭ33 and nϭ34, respectively) or the placebo (nϭ30). Myoblast transfer did not improve regional or global LV function beyond that seen in control patients. The absolute change in ejection fraction (median [interquartile range]) between 6 months and baseline was 4.4% (0.2; 7.3), 3.4% (Ϫ0.3; 12.4), and 5.2% (Ϫ4.4; 11.0) in the placebo, low-dose, and high-dose groups, respectively (Pϭ0.95). However, the high-dose cell group demonstrated a significant decrease in LV volumes compared with the placebo group. Despite a higher number of arrhythmic events in the myoblast-treated patients, the 6-month rates of major cardiac adverse events and of ventricular arrhythmias did not differ significantly between the pooled treatment and placebo groups. Conclusions-Myoblast injections combined with coronary surgery in patients with depressed LV function failed to improve echocardiographic heart function. The increased number of early postoperative arrhythmic events after myoblast transplantation, as well as the capability of high-dose injections to revert LV remodeling, warrants further investigation.

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“…18 Together with the small sample size, this relatively high rate of segmental recovery in the placebo group might have obscured a potential treatment effect.…”

Section: Interpretation Of Efficacy End Pointsmentioning

confidence: 99%

The Myoblast Autologous Grafting in Ischemic Cardiomyopathy (MAGIC) Trial

et al. 2008

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“…Finally, it should be considered that revascularization in patients with a hibernating myocardium may be associated to lower remodeling. (56,57) Other preventive therapeutic approaches for remodeling prevention, attenuation or reversion after infarction -such as cell regeneration; vasopressin antagonists; natriuretic peptides; ventricular synchronization; mechanic devices; nitrates and statins -still need confirmation through clinical trials.…”

Section: Remodeling Prevention -Attenuationreversionmentioning

confidence: 99%

Remodelação ventricular pós-infarto do miocárdio: conceitos e implicações clínicas

Zornoff¹,

Paiva²,

Duarte³

et al. 2009

Arq. Bras. Cardiol.

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Remodeling process after acute myocardial infarction (AMI) is clinically characterized by ventricular cavity increase. In the acute phase, ventricular dilation is a result of infarction expansion process, whereas late cavity dilation is the result of the eccentric hypertrophy process.Ventricular remodeling plays a key role in the pathology of post-infarction ventricular dysfunction. When reacting to aggression, the genetic, structural, and biochemical changes arising from that process will result in the deterioration of the functional ability of the heart in the long run. Signs and symptoms of the onset of heart failure and/or sudden death will result. The mechanisms that have been proposed for the onset of ventricular dysfunction are complex, but the ones to be pointed out are changes in: calcium transit; betaadrenergic pathway; contractile proteins; increased cell death; collagen accumulation; methaloproteases; higher oxidative stress; energy deficit; cytoskeletal, membrane and matrix proteins; and ventricular geometry. Additionally, remodeling is associated to higher prevalence of cardiac rupture, arrhythmia, and aneurysm formation after infarction.Remodeling is therefore associated to impaired postinfarction prognosis. As a result, a better understanding of such process is critical since remodeling course can be modified through a number of therapeutic interventions.

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“…Patency of coronary arteries can also affect LV volumes and shape in patients with repetitive stunning or hibernating myocardium (40). Intervening at this stage of the remodelling process is thought to confer the greatest benefit, before the onset of irreversible necrosis or fixed LV dysfunction.…”

Section: Effect On Cardiac Remodellingmentioning

confidence: 99%

Timing of bypass surgery in stable patients after acute myocardial infarction

Raghavan

Benzaquen

Rudski

2007

Canadian Journal of Cardiology

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R Raghavan, BS Benzaquen, L Rudski. Timing of bypass surgery in stable patients after acute myocardial infarction. Can J Cardiol 2007;23(12):976-982.OBJECTIVES: To determine the optimal timing for bypass surgery in stable patients after acute myocardial infarction (MI). BACKGROUND: Coronary artery bypass graft surgery (CABG) is a proven treatment for coronary artery disease. Because of the hypothesized risk of hemorrhagic transformation, it had become common practice to wait four to six weeks after MI. Recently, improvements in surgical and perioperative management, as well as an increase in pre-CABG in-hospital waiting times and excess burden on health care resources, have pushed surgeons to operate earlier. The optimal timing for a stable patient to undergo CABG after MI is unclear, because there have been no randomized trials to answer this question. METHODS:The published literature comparing early versus late surgical revascularization procedures in stable post-MI patients was reviewed. RESULTS: No randomized, prospective trials were found; however, several retrospective studies were identified. Most series examining Q wave MIs showed that mortality is higher in the early stages post-MI and progressively decreases with time post-MI. When studies examined non-Q wave MIs separately, there appeared to be less of a mortality difference between early and late surgical revascularization. There was a large disparity between the definitions of early surgery post-MI among the studies, some as early as 6 h and others up to eight days. Factors that increased mortality include abnormal left ventricular function and urgency of surgery, and some studies found risk models helpful to define increased risk after infarction. The possible increased risk of early surgery may be balanced against the potential for improved remodelling, improved quality of life and decreased hospital stay costs. CONCLUSIONS: There is a need for a randomized, prospective trial examining the optimal timing for CABG in stable post-MI patients.

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Patients With Hibernating Myocardium Show Altered Left Ventricular Volumes and Shape, Which Revert After Revascularization

Abstract: Hibernating myocardium is associated with major alterations in LV volumes and shape, which significantly revert after revascularization. Thus, chronic dyssynergy per se is sufficient to induce ischemic LV remodeling in patients.

Cited by 116 publications

References 38 publications

The Myoblast Autologous Grafting in Ischemic Cardiomyopathy (MAGIC) Trial

The Myoblast Autologous Grafting in Ischemic Cardiomyopathy (MAGIC) Trial

Remodelação ventricular pós-infarto do miocárdio: conceitos e implicações clínicas

Timing of bypass surgery in stable patients after acute myocardial infarction

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