Dobutamine echocardiography predicts functional outcome after revascularisation in patients with dysfunctional myocardium irrespective of the perfusion pattern on resting thallium-201 imaging
Abstract:Objective-To evaluate whether the predictive value of dobutamine echocardiography for assessing contractile reserve was altered by diVering patterns of regional myocardial perfusion. Patients-31 consecutive patients with symptomatic congestive heart failure (left ventricular ejection fraction < 35%) caused by coronary artery disease. Setting-A district general hospital. Methods-Thallium-201 perfusion imaging and low dose dobutamine (5-15 µg/kg/ min) echocardiography were performed and resting echocardiography … Show more
“…However, it has also been suggested that where there is a severely compromised coronary flow reserve, it is likely that stimulation of the myocardium by even low doses of dobutamine may precipitate myocardial ischemia by increasing the oxygen demand beyond the already compromised threshold [39]. In a study from our institute involving 31 patients with a predominant history of heart failure and severe left ventricular dysfunction (LVEF = 25% 69%), 39% of the severely dysfunctional segments showed normal perfusion, 32 showed moderately reduced perfusion, and 29% were severely underperfused [41]. Contractile response during dobutamine was similar in the normally perfused and moderately underperfused dysfunctional segments (Fig.…”
Section: Dobutamine Echocardiographymentioning
confidence: 96%
“…Although fatty acid oxidation is preserved in hibernating myocardium [23], the clinical results with these tracers have not been encouraging [24]. 11 C-acetate has, however, been used successfully [25]. Uptake of this tracer depends upon myocardial perfusion and its clearance from the myocardium is a measure of oxidative metabolism.…”
Section: Imaging Techniques For Myocardial Viabilitymentioning
confidence: 96%
“…Fatty acids are an important source of energy for the myocardium. Thus, positronemitting fatty acid analogues such as [11] C-palmitate and [18] F-thiaheptadecanoic acid (FTHA) have been also used to assess myocardial viability. Although fatty acid oxidation is preserved in hibernating myocardium [23], the clinical results with these tracers have not been encouraging [24].…”
Section: Imaging Techniques For Myocardial Viabilitymentioning
confidence: 99%
“…An exception is "repetitive stunning," defined as repeated episodes of ischemia producing prolonged post-ischemic contractile dysfunction [6], which is similar to hibernation in that revascularisation has the potential to improve contractile function. Theoretically, hibernation and stunning are different pathophysiologic states but, practically, they are often indistinct, appear to coexist in varying degrees in the same patient or myocardial region, and represent a continuum of the same process [11].…”
Section: Pathophysiology Of Dysfunctional Myocardium In Coronary Artementioning
Left ventricular systolic dysfunction is a recognised feature of heart failure. In developed nations, the leading cause of left ventricular systolic dysfunction is coronary artery disease. Revascularisation is a treatment strategy for patients with predominant symptoms of heart failure and significant left ventricular dysfunction. Presence or absence of myocardial viability has been shown to affect outcome after revascularisation. There are various techniques to assess myocardial viability. However, limitations of current literature, lack of completed randomised trials and high peri-procedural trials create significant uncertainty about the optimal strategy. This review focuses on the role of non-invasive testing for myocardial viability in patients with left ventricular systolic dysfunction and heart failure and also outlines the pros and cons of each technique.
“…However, it has also been suggested that where there is a severely compromised coronary flow reserve, it is likely that stimulation of the myocardium by even low doses of dobutamine may precipitate myocardial ischemia by increasing the oxygen demand beyond the already compromised threshold [39]. In a study from our institute involving 31 patients with a predominant history of heart failure and severe left ventricular dysfunction (LVEF = 25% 69%), 39% of the severely dysfunctional segments showed normal perfusion, 32 showed moderately reduced perfusion, and 29% were severely underperfused [41]. Contractile response during dobutamine was similar in the normally perfused and moderately underperfused dysfunctional segments (Fig.…”
Section: Dobutamine Echocardiographymentioning
confidence: 96%
“…Although fatty acid oxidation is preserved in hibernating myocardium [23], the clinical results with these tracers have not been encouraging [24]. 11 C-acetate has, however, been used successfully [25]. Uptake of this tracer depends upon myocardial perfusion and its clearance from the myocardium is a measure of oxidative metabolism.…”
Section: Imaging Techniques For Myocardial Viabilitymentioning
confidence: 96%
“…Fatty acids are an important source of energy for the myocardium. Thus, positronemitting fatty acid analogues such as [11] C-palmitate and [18] F-thiaheptadecanoic acid (FTHA) have been also used to assess myocardial viability. Although fatty acid oxidation is preserved in hibernating myocardium [23], the clinical results with these tracers have not been encouraging [24].…”
Section: Imaging Techniques For Myocardial Viabilitymentioning
confidence: 99%
“…An exception is "repetitive stunning," defined as repeated episodes of ischemia producing prolonged post-ischemic contractile dysfunction [6], which is similar to hibernation in that revascularisation has the potential to improve contractile function. Theoretically, hibernation and stunning are different pathophysiologic states but, practically, they are often indistinct, appear to coexist in varying degrees in the same patient or myocardial region, and represent a continuum of the same process [11].…”
Section: Pathophysiology Of Dysfunctional Myocardium In Coronary Artementioning
Left ventricular systolic dysfunction is a recognised feature of heart failure. In developed nations, the leading cause of left ventricular systolic dysfunction is coronary artery disease. Revascularisation is a treatment strategy for patients with predominant symptoms of heart failure and significant left ventricular dysfunction. Presence or absence of myocardial viability has been shown to affect outcome after revascularisation. There are various techniques to assess myocardial viability. However, limitations of current literature, lack of completed randomised trials and high peri-procedural trials create significant uncertainty about the optimal strategy. This review focuses on the role of non-invasive testing for myocardial viability in patients with left ventricular systolic dysfunction and heart failure and also outlines the pros and cons of each technique.
“…Contractile reserve, which is a marker of myocardial viability, may be assessed by low-dose dobutamine echocardiography or cardiac MRI [45][46][47][48][49]. Lately, gadolinium-based contrast agents with cardiovascular magnetic resonance (CMR) are used to assess late hyperenhancement of the myocardium, which reflects myocardial necrosis [50,51].…”
Section: Comparison Of Myocardial Contrast Echocardiography With Othementioning
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