Regional dysfunction by equilibrium radionuclide angiocardiography: A clinicopathologic study evaluating the relation of degree of dysfunction to the presence and extent of myocardial infarction

Cabin, Henry S.; Clubb, K.Soni; Vita, Néstor A.; Zaret, Barry L.

doi:10.1016/s0735-1097(87)80265-6

Cited by 45 publications

(7 citation statements)

References 12 publications

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“…8,9 On the other hand, a decreased or delayed pattern of CV may indicate segmental viability of myocardium that has late systolic shortening and so does not always reflect irreversible ischemic injury. 6,8 Indeed, the LVEF significantly improved in group B as well as in group A, which is not surprising given that even a dyskinetic myocardial segment may have a nontransmural MI or even normal myocardium histologically 26,27 and in addition, patients with scar formation on 2-dimenstional echocardiography were excluded from the present study. As mentioned before, the temporal relationship of CV with the cardiac cycle is also a useful marker of myocardial viability.…”

Section: Role Of Ibs In the Assessment Of Myocardial Viabilitymentioning

confidence: 76%

Prediction of Functional Recovery of the Left Ventricle After Coronary Revascularization in Patients With Prior Anterior Myocardial Infarction. A Myocardial Integrated Backscatter Study.

Ito

Suwa

Suzuki

et al. 2002

Circ J

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n some patients with chronic coronary artery disease, persistent left ventricular (LV) dysfunction can be restored by coronary revascularization. Thus, identifying potentially reversible dysfunction has important therapeutic and prognostic implications. Recently, it was reported that the cyclic variation (CV) of integrated backscatter (IBS), which reflects intrinsic contractile performance, 1-6 can predict myocardial viability in patients with reperfused acute myocardial infarction (MI), 7 but this method has not been validated for chronic LV dysfunction. [8][9][10] The purpose of this study was, therefore, to determine whether IBS could identify hibernating myocardium and predict LV functional recovery after coronary revascularization in patients with a remote anterior MI. Circulation Journal Vol.66, October 2002 Methods Selection of PatientsBetween November 1996 and October 1998, 255 patients with angiographically proven coronary artery disease underwent a coronary revascularization procedure and from this group, we prospectively selected 17 patients who met the following inclusion criteria: (1) technically adequate echocardiographic studies allowing the region of interest (ROI) for IBS analysis to be placed in the anterior myocardium that did not include apparent scar formation (wall thickness <5 mm and/or increased acoustic reflectance of the wall compared with the pericardium); (2) remote MI, the onset of which was more than 1 month before the revascularization procedure (48±20 days, range: 29-102); (3) single-vessel coronary artery disease (only the left anterior descending artery), >75% narrowing in diameter on coronary angiography; (4) persistent LV dysfunction (ejection fraction (EF) <50% on angiography); (5) successful revascularization procedure; and (6) stable clinical condition with no major clinical events during the follow-up period (ie, death, reinfarction, coronary bypass surgery or interventional revascularization). Cyclic variation (CV) of myocardial integrated backscatter (IBS), which reflects intrinsic contractile performance, can predict myocardial viability in patients with a reperfused acute myocardial infarction (MI), but the use of this method has not been validated for chronic left ventricular (LV) dysfunction. The aim of this study was to examine whether myocardial IBS was useful for predicting LV functional recovery after coronary revascularization in 17 patients with prior anterior MI and LV dysfunction (ejection fraction <50%). Within 24 h of the revascularization procedure (percutaneous transluminal coronary angioplasty or coronary stenting), IBS curves were obtained by placing the region of interest on the anterior wall on the short-axis IBS image. The patients had repeat left heart catheterization at 3 or 6 months after the revascularization procedure, and were grouped according to the patterns of the IBS curve within the anterior wall. In 8 patients (group A), the IBS curve had a synchronized pattern with the magnitude of CV ≥3.5, and in the remaining 9 patients (group B), the ...

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Section: Role Of Ibs In the Assessment Of Myocardial Viabilitymentioning

confidence: 76%

Prediction of Functional Recovery of the Left Ventricle After Coronary Revascularization in Patients With Prior Anterior Myocardial Infarction. A Myocardial Integrated Backscatter Study.

Ito

Suwa

Suzuki

et al. 2002

Circ J

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“…It is interesting to recall that while the concept of stunning was first derived from experimental models, the concept of hibernation derives from clinical studies documenting that persistent left ventricular wallmotion abnormalities in patients with chronic angina were reversed to normal by successful coronary artery bypass surgery [11][12][13][14][15][16][17][18][19][20][21] or angioplasty [22,23].…”

Section: Outcomes Of Myocardial Ischemiamentioning

confidence: 99%

Hibernating myocardium in patients with coronary artery disease: Identification and clinical importance

Ferrari

Canna

Giubbini

et al. 1992

Cardiovasc Drug Ther

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The term hibernating myocardium describes a particular outcome of myocardial ischemia in which myocytes show a chronically depressed contractile ability but remain viable. Revascularization of hibernating tissue causes a recovery of mechanical function that correlates with long-term survival. Therefore it is important clinically to distinguish hibernating from infarcted myocardium, since asynergies due to hibernation will improve on reperfusion, whilst those due to infarct will not. One suggested technique to identify hibernating myocardium is to stimulate the myocytes acutely, but briefly, by administration of inotropic agents while monitoring contractile function by echocardiography. We report our experience on the use of low dosages of dobutamine. Myocardial viability was validated by measuring the recovery in contraction of the akinetic areas after coronary artery bypass surgery by means of intraoperative epicardial echocardiography. The test has a sensitivity of 93% and a specificity of 78%. It is useful for identification of viable myocardium and also for quantification of intraoperative risk in individual patients. Limitations of this test are related to the presence of downregulation of beta receptors and to the impossibility of differentiating hibernating from stunned myocardium. Another useful technique of identifying hibernating myocardium is the use of radionuclear markers for viability. In our experience the two most important tests are (1) rest-redistribution imaging of thallium 201 (which has a high sensitivity of 93% but a low specificity of 44%) and (2) 99mTc-Sestamibi imaging, which provides information on both perfusion and function with a single injection. This latter technique allows differentiation between stunning and hibernating on the basis of coronary flow which is preserved in stunning and reduced in hibernation.

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“…Postmortem examination of akinetic/dyskinetic and hypokinetic myocardial segments revealed 7% and 52% normal tissue, respectively [12]. Some investigators concluded, therefore, that the reduced contraction may serve as a protective mechanism: by reducing its oxygen demand, the hibernating tissue attempts to maintain viability under the condition of reduced oxygen supply [13].…”

Section: Potential For Recovery Of Myocardium In Hibernationmentioning

confidence: 99%

Recovery of myocardial function in the hibernating heart

Hamm

1992

Cardiovasc Drug Ther

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Impaired contractile performance at rest is not necessarily due to irreversible tissue damage but may relate to the "hibernating" myocardium. Hibernating myocardium has been defined as potentially reversible, chronic contractile dysfunction during prolonged, painless ischemia. The extent and time course of functional recovery after restoration of flow is of major importance for clinical decision making. The existence of hibernating myocardium was first documented in patients following bypass surgery. Angiographic studies in patients undergoing coronary angioplasty revealed immediate recovery of global and regional systolic, as well as diastolic, function after revascularization. Subgroup analysis showed an improvement in patients without previous myocardial infarctions and in those with non-Q-wave infarctions, but a benefit was not consistently seen in patients with transmural infarctions. A further improvement of systolic function after 15 weeks suggests a biphasic course of recovery. Prospective studies must clarify whether the potential for improvement in function constitutes an indication for revascularization independent of clinical symptoms.

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Regional dysfunction by equilibrium radionuclide angiocardiography: A clinicopathologic study evaluating the relation of degree of dysfunction to the presence and extent of myocardial infarction

Cited by 45 publications

References 12 publications

Prediction of Functional Recovery of the Left Ventricle After Coronary Revascularization in Patients With Prior Anterior Myocardial Infarction. A Myocardial Integrated Backscatter Study.

Prediction of Functional Recovery of the Left Ventricle After Coronary Revascularization in Patients With Prior Anterior Myocardial Infarction. A Myocardial Integrated Backscatter Study.

Hibernating myocardium in patients with coronary artery disease: Identification and clinical importance

Recovery of myocardial function in the hibernating heart

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