Stunning, Hibernation, and Assessment of Myocardial Viability

Camici, Paolo G.; Prasad, Sanjay; Rimoldi, Ornella

doi:10.1161/circulationaha.107.702993

Cited by 353 publications

(230 citation statements)

References 129 publications

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“…The general approach for identifying hibernating myocardium is the demonstration of myocyte viability in the setting of decreased flow. The gold standard is to use [ 18 F]-2-deoxy-2-fluoro-Dglucose ( 18 FDG) to identify regions of myocardium with increased glycolytic activity by PET, co-registered with regions of poor perfusion demonstrated by 13 NH 3 -PET, for example [14][15][16]. However, 18 FDG is a relatively non-specific tracer with many practical limitations, the worst being that in ischemic/reperfused myocardium, it severely underestimates glucose uptake [17][18][19][20][21] which can potentially lead to underestimation of viability.…”

Section: Potential Applications Of Cardiac Hypoxia Imagingmentioning

confidence: 99%

PET imaging of cardiac hypoxia: Opportunities and challenges

Handley¹,

Medina²,

Nagel

et al. 2011

Journal of Molecular and Cellular Cardiology

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Myocardial hypoxia is a major factor in the pathology of cardiac ischemia and myocardial infarction. Hypoxia also occurs in microvascular disease and cardiac hypertrophy, and is thought to be a prime determinant of the progression to heart failure, as well as the driving force for compensatory angiogenesis. The non-invasive delineation and quantification of hypoxia in cardiac tissue therefore has the potential to be an invaluable experimental, diagnostic and prognostic biomarker for applications in cardiology. However, at this time there are no validated methodologies sufficiently sensitive or reliable for clinical use. PET imaging provides real-time spatial information on the biodistribution of injected radiolabeled tracer molecules. Its inherent high sensitivity allows quantitative imaging of these tracers, even when injected at subpharmacological (≥pM) concentrations, allowing the non-invasive investigation of biological systems without perturbing them. PET is therefore an attractive approach for the delineation and quantification of cardiac hypoxia and ischemia. In this review we discuss the key concepts which must be considered when imaging hypoxia in the heart. We summarize the PET tracers which are currently available, and we look forward to the next generation of hypoxia-specific PET imaging agents currently being developed. We describe their potential advantages and shortcomings compared to existing imaging approaches, and what is needed in terms of validation and characterization before these agents can be exploited clinically.

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Section: Potential Applications Of Cardiac Hypoxia Imagingmentioning

confidence: 99%

PET imaging of cardiac hypoxia: Opportunities and challenges

Handley¹,

Medina²,

Nagel

et al. 2011

Journal of Molecular and Cellular Cardiology

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“…Исследование CHRISTMAS показало, что у пациентов с большим количеством гибернирующего миокарда (определенным с помо щью эхокардиографии и ОФЭКТ с технецием) на блюдается большее увеличение ФИ ЛЖ при лече нии карведилолом [40]. Это отличается от того, что сообщалось в результатах других исследований, и может отражать процесс оптимизации лечения та ких пациентов [41,42].…”

Section: жизнеспособность и прогнозunclassified

“…В последние 10 лет ме дикаментозное лечение сердечной недостаточности продолжило улучшаться, и были достигнуты значи тельные успехи в методах коронарной реваскуляри зации, что привело к снижению рисков во время и после выполнения процедуры [45]. В связи с этим Camici et al [46] объединили данные 14 нерандоми зированных исследований. Они продемонстрирова ли тенденцию к лучшей выживаемости пациентов с ИБС и дисфункцией ЛЖ, имевших жизнеспособ ный миокард и подвергшихся реваскуляризации, по сравнению с пациентами с жизнеспособным мио кардом, получавшими только медикаментозное ле чение.…”

Section: жизнеспособность и прогнозunclassified

Current state of myocardial revascularization in patients with severe left ventricular systolic dysfunction

Готье

Миронков

Саховский

2017

RJTAO

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In most cases, severe left ventricular systolic dysfunction is a consequence of ischemic heart disease. In clinical condition, current recommendations support myocardial revascularization in patients with ischemic cardiomyo pathy by performing coronary artery bypass grafting. Information on safety and effectiveness of percutaneous coronary intervention in patients with ischemic heart failure is limited. The aim of this review is to study the current state of this problem.

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“…It is likely that shades of gray will yield better insights than black and white. 123 After this series of meta-analyses, several other groups subsequently published further pooled analyses of these and other studies 124,125 also suggesting benefit of revascularization of viable myocardium.…”

Section: Meta-analyses Of Observational Studies Employing Tracer and mentioning

confidence: 99%

Noninvasive assessment myocardial viability: Current status and future directions

Allman

2013

Journal of Nuclear Cardiology

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Observations of reversibility of cardiac contractile dysfunction in patients with coronary artery disease and ischemia were first made more than 40 years ago. Since that time a wealth of basic science and clinical data has been gathered exploring the mechanisms of this phenomenon of myocardial viability and relevance to clinical care of patients. Advances in cardiac imaging techniques have contributed greatly to knowledge in the area, first with thallium-201 imaging, then later with Tc-99m-based tracers for SPECT imaging and metabolic tracers used in conjunction with positron emission tomography (PET), most commonly F-18 FDG in conjunction with blood flow imaging with N-13 ammonia or Rb-82 Cl. In parallel, stress echocardiography has made great progress also. Over time observational studies in patients using these techniques accumulated and were later summarized in several meta-analyses. More recently, cardiac magnetic resonance imaging (CMR) has contributed further information in combination with either late gadolinium enhancement imaging or dobutamine stress. This review discusses the tracer and CMR imaging techniques, the pooled observational data, the results of clinical trials, and ongoing investigation in the field. It also examines some of the current challenges and issues for researchers and explores the emerging potential of combined PET/CMR imaging for myocardial viability.

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Stunning, Hibernation, and Assessment of Myocardial Viability

Cited by 353 publications

References 129 publications

PET imaging of cardiac hypoxia: Opportunities and challenges

PET imaging of cardiac hypoxia: Opportunities and challenges

Current state of myocardial revascularization in patients with severe left ventricular systolic dysfunction

Noninvasive assessment myocardial viability: Current status and future directions

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