Prognostic value of the amount of dysfunctional but viable myocardium in revascularized patients with coronary artery disease and left ventricular dysfunction

Meluzı́n, Jaroslav; Špinarová, Lenka; Černý, Jan; Frélich, Milan; Štětka, František; Popelová, Jana; Štípal, Roman

doi:10.1016/s0735-1097(98)00324-6

Cited by 222 publications

(115 citation statements)

References 36 publications

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“…5 An asynergic segment was considered to have functional recovery in the follow-up control when, compared with the respective baseline study, it showed a wall motion improvement of 1 or more grades 9 or of 2 or more grades in the case of dyskinesia. 10 …”

Section: Discussionmentioning

confidence: 99%

Low-dose dobutamine nitrate-enhanced technetium 99m sestamibi gated SPECT versus low-dose dobutamine echocardiography for detecting reversible dysfunction in ischemic cardiomyopathy

Leoncini

2002

Journal of Nuclear Cardiology

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Background. The simultaneous assessment of perfusion and function with the use of technetium 99m sestamibi gated single photon emission computed tomography (SPECT) is helpful for the detection of myocardial viability, but its value in comparison with more established methods is not yet defined.Methods and Results. This study compared low-dose dobutamine (LDD) nitrate-enhanced gated SPECT with LDD echocardiography for predicting recovery of regional ventricular function after revascularization in 25 patients with ischemic cardiomyopathy. In both studies, regional function (wall motion and thickening) at rest, during inotropic stimulation, and after revascularization was scored by a 4-point scale. In LDD echocardiography, the prediction of reversible dysfunction was based on the recognition of contractile reserve in asynergic (hypokinetic or a-dyskinetic) segments. In LDD gated sestamibi SPECT, reversible dysfunction was predicted on the basis of perfusion quantification (sestamibi uptake > 50%) in a-dyskinetic segments and on the basis of contractile reserve in hypokinetic segments. LDD echocardiography predicted reversible dysfunction with sensitivity, specificity, and global accuracy of 57%, 85%, and 75%, respectively. The sensitivity and specificity of LDD gated SPECT for identifying dysfunctional segments capable of functional recovery were 77% and 88%, respectively, with a diagnostic accuracy of 84% (P < .02 vs LDD echocardiography).Conclusions. The combined use of 2 different markers of viability, such as cellular integrity in a-dyskinetic segments and contractile reserve in hypokinetic segments, as permitted by LDD gated sestamibi SPECT, showed higher predictive accuracy for reversible dysfunction than the assessment of contractile reserve in all asynergic segments with LDD echocardiography. (

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Section: Discussionmentioning

confidence: 99%

Low-dose dobutamine nitrate-enhanced technetium 99m sestamibi gated SPECT versus low-dose dobutamine echocardiography for detecting reversible dysfunction in ischemic cardiomyopathy

Leoncini

2002

Journal of Nuclear Cardiology

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“…Segment functional recovery after revascularisation was defined on the basis of a decrease by ≥1 grade in wall motion score at follow-up [16]. However, a change from dyskinesia to akinesia was not considered to be significant [19]. Gated SPECT processing and calculation of ejection fraction were performed by an automated and validated method [6].…”

Section: Study Protocolmentioning

confidence: 99%

Use of 99mTc-sestamibi gated SPECT to assess the influence of anterograde flow before primary coronary angioplasty on tissue salvage and functional recovery in acute myocardial infarction

Leoncini

Bellandi

Sciagrà

et al. 2004

Eur J Nucl Med Mol Imaging

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Abstract.Purpose: Preserved thrombolysis in myocardial infarction (TIMI) flow before percutaneous coronary intervention (PCI) in acute myocardial infarction is related to improved outcome. Gated single-photon emission computed tomography (SPECT) allows the simultaneous assessment of left ventricular perfusion and function. We evaluated the initial risk area and subsequent evolution of perfusion and function according to TIMI flow before successful primary PCI. Methods: In 36 patients, treated with abciximab, primary PCI and stenting, 99m Tc-sestamibi was injected before PCI and gated SPECT acquired thereafter. Gated SPECT was repeated 7 and 30 days later. Perfusion defect, wall motion score index, left ventricular ejection fraction and volumes were examined. Results: Before PCI, 14 patients (group A) showed TIMI flow 2-3 and 22 (group B) TIMI flow 0-1, but no differences in clinical variables, initial risk area, wall motion score, ejection fraction or volumes. Perfusion defect was smaller in group A at 7 (9%±11% vs 19%±14%, p<0.02) and 30 days (7%±7% vs 16%±12%, p<0.02) and the salvage index was higher at 30 days (77%±22% vs 55%±28%, p<0.02). Wall motion score was lower in group A at 30 days (p<0.05). Ejection fraction significantly improved in both groups at 7 and 30 days. Enddiastolic volume showed a trend towards a reduction in group A, whilst it was significantly increased in group B. Conversely, end-systolic volume was significantly decreased in group A but remained unchanged in group B. Conclusion: In the setting of optimal myocardial reperfusion for myocardial infarction, preserved TIMI flow before PCI does not limit the initial risk area but it does improve myocardial salvage and functional recovery.

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“…Improvement appeared to occur only in patients limited by angina, whereas patients whose primary limitation was dyspnea or fatigue had no improvement in three-year survival rates (19). Evidence from cardiac imaging studies suggesting that CABG is particularly beneficial for patients with extensive myocardial viability or hibernating myocardium in coronary territories amenable to surgery supports the results from the CASS registry (23)(24)(25).…”

Section: The Role Of Cabgmentioning

confidence: 79%

The heart failure challenge: Optimizing medical and surgical management

Racine

Rouleau

2006

Canadian Journal of Cardiology

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Prognostic value of the amount of dysfunctional but viable myocardium in revascularized patients with coronary artery disease and left ventricular dysfunction

Abstract: In revascularized patients with CAD and moderate or severe LV dysfunction, the presence of a large amount of dysfunctional but viable myocardium identifies patients with the best prognosis.

Cited by 222 publications

References 36 publications

Low-dose dobutamine nitrate-enhanced technetium 99m sestamibi gated SPECT versus low-dose dobutamine echocardiography for detecting reversible dysfunction in ischemic cardiomyopathy

Low-dose dobutamine nitrate-enhanced technetium 99m sestamibi gated SPECT versus low-dose dobutamine echocardiography for detecting reversible dysfunction in ischemic cardiomyopathy

Use of 99mTc-sestamibi gated SPECT to assess the influence of anterograde flow before primary coronary angioplasty on tissue salvage and functional recovery in acute myocardial infarction

The heart failure challenge: Optimizing medical and surgical management

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