Hibernating Myocardium

Elsässer, Albrecht; Schlepper, M; Klövekorn, W. P.; Cai, Wei-jun; Zimmermann, René; Müller, Klaus D.; Sträßer, Rudolf; Kostin, Sava; Gagel, Christina; Münkel, Brigitte; Schäper, Wolfgang; Schaper, Jutta

doi:10.1161/01.cir.96.9.2920

Cited by 307 publications

(69 citation statements)

References 33 publications

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“…The absence of late enhancement in our 3 patients with ICM may well signify the presence of hibernating myocardium [28,29]. Failure to revascularize dysfunctional, hibernating segments can lead to myocardial apoptosis [30].…”

Section: Discussionmentioning

confidence: 99%

Can late gadolinium enhancement by cardiovascular magnetic resonance identify coronary artery disease as the etiology of new onset congestive heart failure?

Schietinger

Vörös

Isbell

et al. 2007

Int J Cardiovasc Imaging

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Background-New left ventricular systolic dysfunction affects 500,000 Americans and coronary artery disease (CAD) is responsible for two-thirds of cases. Identifying CAD has both prognostic and therapeutic implications. We evaluated the ability of late gadolinium enhancement (LGE) by cardiovascular magnetic resonance imaging (CMR) to detect CAD as the etiology of recent onset congestive heart failure (CHF).

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Section: Discussionmentioning

confidence: 99%

Can late gadolinium enhancement by cardiovascular magnetic resonance identify coronary artery disease as the etiology of new onset congestive heart failure?

Schietinger

Vörös

Isbell

et al. 2007

Int J Cardiovasc Imaging

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“…[1][2][3] Chronically dysfunctional segments exhibit distinct morphological changes at both the cardiomyocyte and extracellular matrix levels. 4 -6 Cardiomyocytes in hibernating areas demonstrate loss of contractile material, 7 glycogen accumulation, 4,8 and may undergo dedifferentiation, expressing contractile proteins specific to the fetal heart. 9,10 In addition, hibernating myocardial segments demonstrated increased expression of extracellular matrix proteins, 7 when compared with normal myocardial segments.…”

mentioning

confidence: 99%

“…4 -6 Cardiomyocytes in hibernating areas demonstrate loss of contractile material, 7 glycogen accumulation, 4,8 and may undergo dedifferentiation, expressing contractile proteins specific to the fetal heart. 9,10 In addition, hibernating myocardial segments demonstrated increased expression of extracellular matrix proteins, 7 when compared with normal myocardial segments. Furthermore, dysfunctional myocardial segments with improved function after revascularization show significantly less tissue fibrosis 8,11,12 than myocardium with persistent dysfunction.…”

mentioning

confidence: 99%

Evidence for an Active Inflammatory Process in the Hibernating Human Myocardium

Frangogiannis

Shimoni

Chang

et al. 2002

The American Journal of Pathology

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Myocardial hibernation refers to a state of prolonged impairment of left ventricular function in the presence of coronary artery disease, which may be reversed by revascularization. In this study we present evidence for a local inflammatory reaction in hibernating myocardial segments from patients undergoing coronary revascularization. We obtained transmural myocardial biopsies guided by transesophageal echocardiography from patients with ischemic ventricular dysfunction undergoing bypass surgery. Among the 28 biopsied segments included in the study, 23 showed evidence of systolic dysfunction. The majority of dysfunctional segments (85.7%) were viable ( 201 Tl uptake > 60%). The samples were stained with markers for mast cells, mature resident macrophages, and the monoclonal antibody Mac387 that labels newly recruited myeloid cells. Dysfunctional segments showed more extensive fibrosis and higher macrophage density than normal segments. Among the 23 dysfunctional segments, 12 recovered function as assessed with echocardiograms 3 months after revascularization. Segments with postoperative functional recovery had comparable macrophage and mast cell density with those showing persistent dysfunction. However, biopsied segments that subsequently recovered function contained significantly higher numbers of newly recruited Mac387-positive leukocytes (18.7 ؎ 3.1 cells/mm 2 , n ‫؍‬ 12 versus 8.6 ؎ 0.9 cells/mm 2 , n ‫؍‬ 11; P ‫؍‬ 0.009). In addition, monocyte chemotactic protein-1, a potent mononuclear cell chemoattractant, was predominantly expressed in segments with recovery of function. Myocardial hibernation is associated with an inflammatory response leading to active leukocyte recruitment. Dysfunctional myocardial segments that show an active inflammatory reaction have a greater potential for recovery of function after revascularization. We pos-

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“…Such examination of ischemic, dysfunctional myocardium reveals a number of distinct features, including progressive loss of myocyte bundles, increasing collagen and disorganized muscle fascicular structure, also fibrosis, increased glycogen storage, mitochondrial changes, reduction in connexin 43, vacuolization, and a reversion to fetal myoglobin. 14 …”

Section: Histopathologic Studiesmentioning

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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Hibernating Myocardium

Cited by 307 publications

References 33 publications

Can late gadolinium enhancement by cardiovascular magnetic resonance identify coronary artery disease as the etiology of new onset congestive heart failure?

Can late gadolinium enhancement by cardiovascular magnetic resonance identify coronary artery disease as the etiology of new onset congestive heart failure?

Evidence for an Active Inflammatory Process in the Hibernating Human Myocardium

Noninvasive assessment myocardial viability: Current status and future directions

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