No differences in rest myocardial blood flow in stunned and hibernating myocardium: insights into the pathophysiology of ischemic cardiomyopathy

Benz, Dominik C.; Dahlen, Anita P von; Huang, Wenjie; Messerli, Michael; Felten, Elia von; Benetos, Georgios; Giannopoulos, Andreas A.; Fuchs, Tobias A.; Gräni, Christoph; Gebhard, Cathérine; Pazhenkottil, Aju P.; Gaemperli, Oliver; Kaufmann, Philipp A.; Buechel, Ronny R.

doi:10.1007/s00259-019-04440-2

Cited by 10 publications

(8 citation statements)

References 26 publications

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“…This is in line with PET-perfusion-based studies that could demonstrate that impaired myocardium (both stunned and hibernating myocardium as well as scar) showed reduced myocardial blood flow under resting conditions as compared to remote myocardium. 20 We consider this a particularly important finding and in line with the assumption that impaired myocardial perfusion in severe coronary artery disease might be misdiagnosed in semiquantitative assessment, but revealed using SUV-based quantification, possibly leading to higher sensitivity of the examination and the detection of potentially life-threatening conditions. 4 ROC analysis suggests that SUV peak and SUV max might be useful markers to differentiate between patients with and without TVCAD with a high sensitivity, which is warranted in a setting of a life-threatening disease.…”

Section: Discussionsupporting

confidence: 73%

Quantitative myocardial perfusion SPECT/CT for the assessment of myocardial tracer uptake in patients with three-vessel coronary artery disease: Initial experiences and results

Lehner

Nowak

Zacherl

et al. 2022

Journal of Nuclear Cardiology

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Background To evaluate quantitative myocardial perfusion SPECT/CT datasets for routine clinical reporting and the assessment of myocardial tracer uptake in patients with severe TVCAD. Methods MPS scans were reconstructed as quantitative SPECT datasets using CTs from internal (SPECT/CT, Q_INT) and external (PET/CT, Q_EXT) sources for attenuation correction. TPD was calculated and compared to the TPD from non-quantitative SPECT datasets of the same patients. SUVmax, SUVpeak, and SUVmean were compared between Q_INT and Q_EXT SPECT datasets. Global SUVmax and SUVpeak were compared between patients with and without TVCAD. Results Quantitative reconstruction was feasible. TPD showed an excellent correlation between quantitative and non-quantitative SPECT datasets. SUVmax, SUVpeak, and SUVmean showed an excellent correlation between Q_INT and Q_EXT SPECT datasets, though mean SUVmean differed significantly between the two groups. Global SUVmax and SUVpeak were significantly reduced in patients with TVCAD. Conclusions Absolute quantification of myocardial tracer uptake is feasible. The method seems to be robust and principally suitable for routine clinical reporting. Quantitative SPECT might become a valuable tool for the assessment of severe coronary artery disease in a setting of balanced ischemia, where potentially life-threatening conditions might otherwise go undetected.

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Section: Discussionsupporting

confidence: 73%

Quantitative myocardial perfusion SPECT/CT for the assessment of myocardial tracer uptake in patients with three-vessel coronary artery disease: Initial experiences and results

Lehner

Nowak

Zacherl

et al. 2022

Journal of Nuclear Cardiology

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“…From our point of view, in parallel with medical publications especially from nuclear medicine working field (11)(12)(13)(14) , F 18-FDG cardiac PET/CT is with higher accuracy and sensitivity for viability detection when compared to other techniques such as technetium SPECT and dobutamine stress echocardiographic tests. Nevertheless, Tc-99-m-MIBI SPECT is a valuable technique to evaluate perfusion.…”

Section: Discussionmentioning

confidence: 83%

Preoperative Correction of Tc-99-m-MIBI SPECT by F<sup>18</sup>-FDG Cardiac PET/CT for Myocardial Viability Before CABG

Talay¹,

Talay²

2020

ejcm

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Objectives: Coronary artery bypass graft (CABG)surgery has been safely practiced on cases with poor left ventricular ejection fraction (LVEF). Although adversely effects of surgery with higher mortality and morbidity rates, preoperative myocardial viability defines outcome. Thus, it is crucial to determine preoperative left ventricular myocardial tissue viability for acceptable postoperative results in this group of patients. This multi-center prospective study focuses of assessment of myocardial perfusion and viability by comparison of two different nuclear medicine imaging techniques; technetium 99-m-methoxy-isobutyl-isonitrile single photon emission computed tomography (Technetium-99-m-MIBI SPECT) and cardiac fluorodeoxyglucose positron emission tomography-computed tomography (F 18 -FDG Cardiac PET/CT). Materials and Methods:Study is performed by ethical approval and Helsinki protocols. Each patient was evaluated by Technetium-99-m-MIBI SPECT and F 18 -FDG Cardiac PET/CT for myocardial viability detection prior to CABG surgery. Technetium-99-m-MIBI SPECT and F 18 -FDG Cardiac PET/CT was evaluated in 191 cases preoperatively. These 191 cases (mean age 64±9.1 and male n=103, 53.9%) with LVEF ≤35% were evaluated for coronary revascularization preoperatively.Results: Study data accumulated from cases of CABG (n=191) with preoperative LVEF measurements between 35% to 20% (n=154, 80.6%) and lower than 20% (n=37, 19.3%). Technetium-99-m-MIBI SPECT imaging was performed before F 18 -FDG Cardiac PET/CT in all cases. By these evaluations, 1896 segments were detailed in total. For Technetium-99-m-MIBI SPECT, 1036 segments displayed normal Technetium-99-m-MIBI uptake (≥70%, classification 2). On the other hand, 860 segments displayed reduced Technetium-99-m-MIBI uptake with Abstract Research Article

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“…In normal myocardium, increases in metabolic demand due to intensification of myocardial work are met by regional increases in blood flow as well as increases in oxygen extraction [36]. Postischemic myocardial stunning and myocardial hibernation have been described in animals [37,38] and patients [35,39] and designate viable but chronically dysfunctional states [40]. Myocardial stunning refers to persistent (but reversible) contractile dysfunction [41,42] produced by a relatively brief ischemic period [43].…”

Section: Myocardial Stunning and Hibernationmentioning

confidence: 99%

“…Myocardial hibernation, on the other hand, refers to viable but chronically dysfunctional myocardium that may be related to poor resting perfusion [35], or general absence of perfusion abnormalities [44,45] but the latter has not been clearly established [46,47]. Recent findings suggest that repetitive ischemia, chronic stunning and hibernation are linked as a continuum [40]; in other words, stunned myocardium can progressively transform into hibernating myocardium. For both dysfunctional myocardial states, downregulation of contractile function might be a cellular adaptive mechanism to facilitate preservation of myocardial integrity and viability [35].…”

Section: Myocardial Stunning and Hibernationmentioning

confidence: 99%

“…Perfusion-contraction matching may be key to myocardial hibernation but this may not be so for myocardial stunning; a number of review articles on this subject are available [48][49][50]. Whether contractile dysfunction can be reversed by improved revascularization in stunned or hibernating myocardium is moot after the formation of scar [40].…”

Section: Myocardial Stunning and Hibernationmentioning

confidence: 99%

See 1 more Smart Citation

Acute Myocardial Infarction: Perspectives on Physiopathology of Myocardial Injury and Protective Interventions

Kingma¹

2021

Cardiac Diseases - Novel Aspects of Cardiac Risk, Cardiorenal Pathology and Cardiac Interventions

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Diffuse coronary artery injury produces a host of physiopathological, structural and metabolic changes in cardiocytes that, if not rectified, result in significant loss of functional myocardium to cause cardiac contractile dysfunction. Restoration of blood perfusion to the infarct-related artery helps to limit the acute effects of myocardial infarction; however, cardiocyte injury may be exacerbated because of the restoration of blood perfusion to the ischemic zone (i.e. reperfusion injury). Various manifestations of reperfusion injury include no-reflow, myocardial stunning or hibernation and ventricular arrhythmias. Consequently, reperfusion of an infarct related artery is often viewed in the context of being a "double-edged sword." Pharmacologic and non-pharmacologic interventions have been investigated in pre-clinical and clinical studies in the hunt to develop strategies to protect cardiomyocytes against the long-term effects of ischemia, or delay development of necrosis (resulting from ischemia or reperfusion). This book chapter will update current thinking on cardioprotective strategies to improve clinical outcomes in patients with coronary artery disease.

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No differences in rest myocardial blood flow in stunned and hibernating myocardium: insights into the pathophysiology of ischemic cardiomyopathy

Cited by 10 publications

References 26 publications

Quantitative myocardial perfusion SPECT/CT for the assessment of myocardial tracer uptake in patients with three-vessel coronary artery disease: Initial experiences and results

Quantitative myocardial perfusion SPECT/CT for the assessment of myocardial tracer uptake in patients with three-vessel coronary artery disease: Initial experiences and results

Preoperative Correction of Tc-99-m-MIBI SPECT by F<sup>18</sup>-FDG Cardiac PET/CT for Myocardial Viability Before CABG

Acute Myocardial Infarction: Perspectives on Physiopathology of Myocardial Injury and Protective Interventions

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