Evaluation of myocardial ischemia and viability by noninvasive cardiac imaging

Katikireddy, Chandra; Mann, Noelle; Brown, David L.; Tosh, Andrew Van; Stergiopoulos, Kathleen

doi:10.1586/erc.11.161

Cited by 9 publications

(35 citation statements)

References 89 publications

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“…Electrocardiography, Echocardiography, exercise test, cardiac nuclear scan and angiography are used for evaluation of ischemic heart disease (IHD) in diabetic patients [ [14] , [15] , [16] ]. Furthermore, coronary angiography is the most accruable method for assessment of IHD, but it is invasive and has some complications [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Association of carotid intima-media thickness with exercise tolerance test in type 2 diabetic patients

Momeni

Taheri

Mansuri

et al. 2018

IJC Heart & Vasculature

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AimsAtherosclerosis and ischemic heart disease are more common in diabetic patients. Atherosclerosis process can disturb the normal functioning of the vascular endothelium and increase vessel wall thickness. The aim of this study was the comparison of Carotid intima-media thickness (CIMT) with Exercise tolerance test as an alternative way to evaluate cardiac ischemia in diabetic patients.MethodsIn a cross-sectional study, 30 diabetic patients with positive exercise test and 30 diabetic patients with negative exercise test were enrolled. CIMT of the carotid artery in both groups of patients was measured.ResultCIMT in the patients with positive and negative exercise test were 1.04 ± 0.21 mm and 0.61 ± 0.11 mm, respectively (P < 0.001). CIMT in positive exercise test group was positively associated with age and negatively associated with gender, FBS, HDL and LDL cholesterol and in negative exercise group was negatively associated with gender, age, FBS, HDL and LDL cholesterol.ConclusionConsidering observed significant positive association between CIMT with result of exercise tolerance test (ETT) in type 2 diabetic patients, it may possible to use CIMT as an inexpensive and non-invasive method for evaluation of ischemic heart disease in diabetic patients.

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Section: Introductionmentioning

confidence: 99%

Association of carotid intima-media thickness with exercise tolerance test in type 2 diabetic patients

Momeni

Taheri

Mansuri

et al. 2018

IJC Heart & Vasculature

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“…Classically, four responses are noted in a dysfunctional myocardial response to dobutamine. These are as follows [ 30 – 33 ]: Biphasic response: low-dose dobutamine (defined as 5–10 μ g/kg/min) can increase contractility in dysfunctional segments which are still viable. At higher doses (10–40 μ g/kg/min), wall motion in these segments may further improve or paradoxically diminish, reflecting tachycardia-induced ischemia.…”

Section: Methods Of Viability Assessmentmentioning

confidence: 99%

Myocardial Viability: From Proof of Concept to Clinical Practice

Bhat

Gan

Tan

et al. 2016

Cardiology Research and Practice

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Ischaemic left ventricular (LV) dysfunction can arise from myocardial stunning, hibernation, or necrosis. Imaging modalities have become front-line methods in the assessment of viable myocardial tissue, with the aim to stratify patients into optimal treatment pathways. Initial studies, although favorable, lacked sufficient power and sample size to provide conclusive outcomes of viability assessment. Recent trials, including the STICH and HEART studies, have failed to confer prognostic benefits of revascularisation therapy over standard medical management in ischaemic cardiomyopathy. In lieu of these recent findings, assessment of myocardial viability therefore should not be the sole factor for therapy choice. Optimization of medical therapy is paramount, and physicians should feel comfortable in deferring coronary revascularisation in patients with coronary artery disease with reduced LV systolic function. Newer trials are currently underway and will hopefully provide a more complete understanding of the pathos and management of ischaemic cardiomyopathy.

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“…19 Metaanalyses have indicated a superior diagnostic accuracy of PET in comparison to other modalities to detect VM. 5 Limitations of PET include the lack of readily available scanners due to high cost, the complex, lengthy patient preparation protocols. Other shortcomings of PET imaging include, its inability to detect small subendocardial infarcts and variability of FDG uptake which can be impacted by certain medications (levothyroxine), diabetes, age, sex, and heart failure (20).…”

Section: Positron Emission Tomography (Pet)mentioning

confidence: 99%

“…If LGE is <50% of segmental thickness or if myocardium is severely thinned and akinetic, the predictive accuracy of functional recovery with therapy can be further enhanced by demonstrating contractile reserve with low dose dobutamine. 5 Updated version of CMR standardized protocols from 2020 provide, further details of LGE imaging. 20 Of note, CMR contraindications such as claustrophobia, non-MRI conditional implanted devices and selective metallic implants preclude the utility of CMR.…”

Section: Low Dose Dobutamine Stress Mrimentioning

confidence: 99%

Myocardial viability assessment and utility in contemporary management of ischemic cardiomyopathy

Katikireddy

Samim

2022

Clinical Cardiology

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Background: In clinical practice, we encounter ischemic cardiomyopathy (ICM) with underlying viable, dysfunctional myocardium on a regular basis. Evidence from the Surgical Treatment for Ischemic Heart failure (STICH) and its Extension Study is supportive of improved outcomes with coronary revascularization, irrespective of myocardial viable status. However, Dobutamine stress echocardiography (DSE) and single-photon emission computed tomography (SPECT), used in STICH to assess myocardial viability may fail to distinguish hibernating myocardium from scar due to suboptimal image resolution and poor tissue characterization.Hypothesis: Cardiac magnetic resonance (CMR) and positron emission tomography (PET) can precisely quantify myocardial scar and identify metabolically active, viable myocardium respectively. Unlike DSE and SPECT, CMR and PET allow examining myocardial status as a contiguous spectrum from viable to partially viable myocardium with varying degrees of subendocardial scar and nonviable myocardium with predominantly transmural scar, the therapeutic and prognostic determinants of ICM.Methods: Under the guidance of CMR and PET imaging, myocardium can be distinguished viable from partially viable with subendocardial scar and predominantly transmural scar. In ICM, optimal medical therapy and coronary revascularization of viable/partially viable myocardium but not transmural scar may improve outcomes in patients with acceptable procedural risk.Results: Coronary revascularization of partially viable and viable myocardial territory may improve clinical outcomes by preventing future ischemic, infarct events and further worsening of left ventricular remodeling and function.Conclusions: When deciding if coronary revascularization is appropriate in a patient with ICM, it is essential to take a patient-tailored, comprehensive approach incorporating myocardial viability, ischemia, and scar data with others such as procedural risk, and patient's comorbidities.

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Evaluation of myocardial ischemia and viability by noninvasive cardiac imaging

Cited by 9 publications

References 89 publications

Association of carotid intima-media thickness with exercise tolerance test in type 2 diabetic patients

Association of carotid intima-media thickness with exercise tolerance test in type 2 diabetic patients

Myocardial Viability: From Proof of Concept to Clinical Practice

Myocardial viability assessment and utility in contemporary management of ischemic cardiomyopathy

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