Pathophysiology of Chronic Left Ventricular Dysfunction

Marinho, Norma Vasconcelos Saldanha; Keogh, Bruce; Costa, Durval C.; Lammerstma, Adriaan A.; Ell, Peter J.; Camici, Paolo G.

doi:10.1161/01.cir.93.4.737

Cited by 171 publications

(23 citation statements)

References 37 publications

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“…Recent quantitative blood flow measurements have challenged the model of chronic myocardial underperfusion as the main cause of hibernating myocardium [5, 6, 7]. Marinho et al [7]found that chronic dysfunctional segments with functional recovery after revascularization had normal perfusion compared to remote normal contracting myocardium.…”

Section: Discussionmentioning

confidence: 99%

“…Vanoverschelde et al [5]were the first who demonstrated that dysfunctional but noninfarcted collateral-dependent myocardium had normal myocardial blood flow as compared to remote myocardium. More recent studies in patients with chronic infarction confirmed that dyskinetic myocardium which recovered after revascularization had normal perfusion at rest [6, 7]. …”

Section: Introductionmentioning

confidence: 99%

“…Chronically dysfunctional myocardium with reduced perfusion, but preserved F-18 deoxyglucose (FDG) uptake frequently shows functional improvement after revascularization [3, 4]. However, recent studies using quantitative positron emission tomography (PET) have challenged the concept that dysfunctional but viable myocardium is due to a misbalance between myocardial perfusion and glucose metabolism [5, 6, 7]. Vanoverschelde et al [5]were the first who demonstrated that dysfunctional but noninfarcted collateral-dependent myocardium had normal myocardial blood flow as compared to remote myocardium.…”

Section: Introductionmentioning

confidence: 99%

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Prediction of Left Ventricular Functional Recovery by Dobutamine Echocardiography, F-18 Deoxyglucose or <sup>99m</sup>Tc Sestamibi Nuclear Imaging in Patients with Chronic Myocardial Infarction

et al. 2002

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Background: Currently, several modalities are available to predict viability, however, studies comparing various modalities validated by functional recovery after revascularization are scarce. This study analyzed the relative merits of low-dose dobutamine echocardiography, F-18 deoxyglucose (FDG) positron emission tomography (PET) and ^99mTc sestamibi single-photon emission computed tomography to predict functional recovery after revascularization in patients with chronic myocardial infarction. Methods: Patients with chronic coronary occlusion (duration: 3.1 ± 4.8 years) and impaired left ventricular function (ejection fraction: 42 ± 13%) underwent low-dose dobutamine echocardiography (20 µg/kg/min), FDG-PET and ^99mTc sestamibi imaging before revascularization. Revascularization was performed irrespective of any viability data. Follow-up angiography was obtained 4.8 ± 2.5 months after revascularization. Results: Viability analysis was performed in 34 patients with patent target vessel at follow-up, of whom 9 (27%) exhibited functional recovery on left ventricular angiography. For dobutamine echocardiography, improvement of ≧2 adjacent akinetic segments resulted in improved sensitivity of 89% and specificity of 80% to predict functional recovery. For glucose metabolism, FDG uptake >55% was an optimal threshold yielding a sensitivity of 89% and a specificity of 68%. With respect to perfusion, ^99mTc sestamibi uptake >60% was the best cutoff resulting in a sensitivity and a specificity of 56 and 88%, respectively. A concordant match of FDG >55% and of ^99mTc sestamibi >50% resulted in optimized sensitivity (78%) and specificity (80%) with dual imaging. Conclusions: Recovery of chronically dysfunctional myocardium can be predicted with high accuracy by stimulation of contractile reserve or by concordant match of preserved glucose metabolism and residual perfusion.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prediction of Left Ventricular Functional Recovery by Dobutamine Echocardiography, F-18 Deoxyglucose or <sup>99m</sup>Tc Sestamibi Nuclear Imaging in Patients with Chronic Myocardial Infarction

et al. 2002

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“…It has been postulated that repetitive stunning of the type shown by us may result in chronic LV impairment. 28 Identification of clinically available therapeutic strategies that attenuate stunning and therefore lessen the impact of ischemia on LV function represent an important step in improving the medical management of patients with coronary artery disease.…”

Section: Discussionmentioning

confidence: 99%

Randomized, Double-Blind Crossover Study to Investigate the Effects of Amlodipine and Isosorbide Mononitrate on the Time Course and Severity of Exercise-Induced Myocardial Stunning

et al. 1998

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Background-Myocardial stunning may cause prolonged left ventricular dysfunction after exercise-induced ischemia that can be attenuated by calcium antagonists in animal models. To assess their effects in humans, we performed a randomized, double-blind crossover study comparing the calcium antagonist amlodipine (10 mg once daily) versus isosorbide mononitrate (ISMN, 50 mg once daily) on postexercise stunning. Methods and Results-Twenty-four men with chronic stable angina and normal left ventricular function underwent serial quantitative exercise stress echocardiography after 3 weeks on each treatment to assess the degree of postexercise stunning with simultaneous sestamibi single-photon emission computed tomography perfusion scans at peak stress to quantify the ischemic burden. Exercise time (Pϭ1), maximum ST depression (Pϭ0.48), and sestamibi single-photon emission computed tomography scores (Pϭ0.17) were unchanged between treatments. Stunning occurred more often with ISMN than amlodipine (82% versus 48%). The global and segmental stress echocardiography parameters of stunning were attenuated in patients while taking amlodipine compared with ISMN. Shortening fractions and ejection fractions were less impaired 30 minutes after exercise in patients receiving amlodipine (3.5Ϯ1.4% versus 2.5Ϯ1.4%, Pϭ0.014, and 59.7Ϯ5.4% versus 54.5Ϯ8%, PϽ0.001); similarly, the isovolumic relaxation period was less prolonged with amlodipine (93Ϯ15.5 versus 106.3Ϯ14.9 ms, Pϭ0.018). Conclusions-Despite comparable levels of ischemia, amlodipine attenuated stunning when compared with ISMN. This beneficial effect may relate to a prevention of the calcium overload implicated in the pathogenesis of stunning.(Circulation. 1998;98:749-756.)

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“…[10] However, studies of myocardial perfusion using positron emission tomography (PET) showed that myocardial blood flow in hibernating segments was normal, or near normal, in patients with left ventricular dysfunction due to coronary disease. [11,12] Even where myocardial blood flow was found to be reduced, the magnitude of decrease was insufficient to explain the severity of contractile dysfunction. [13] Myocardial hibernation is therefore now thought of as a form of chronic stunning.…”

Section: Pathophysiology Of Hibernating Myocardiummentioning

confidence: 99%

Viability testing to guide myocardial revascularisation in patients with heart failure

Cahill

Kharbanda

2018

Indian J Thorac Cardiovasc Surg

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Myocardial revascularisation has the potential to restore ventricular function and improve survival in patients with heart failure due to underlying coronary artery disease. Viability testing is routinely used to identify which patients are likely to benefit, given that revascularisation may entail substantial procedural risk. However, while the concept of viability testing and revascularisation of patients with 'hibernating myocardium' is strongly supported by observational series, randomised studies have failed to demonstrate clear benefit. This divergence in the evidence base is reflected in current European and US guidelines, in which viability testing has a class II recommendation. In this article, we review the current evidence for routine viability testing prior to revascularisation of patients with heart failure, outline its use in clinical practice and discuss ongoing trials in the field.

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Pathophysiology of Chronic Left Ventricular Dysfunction

Abstract: The results suggest that resting MBF measured with 15O-labeled water in chronically dysfunctional segments is not reduced and that the myocardium of these patients is less sensitive to insulin than that of normal subjects.

Cited by 171 publications

References 37 publications

Prediction of Left Ventricular Functional Recovery by Dobutamine Echocardiography, F-18 Deoxyglucose or <sup>99m</sup>Tc Sestamibi Nuclear Imaging in Patients with Chronic Myocardial Infarction

Prediction of Left Ventricular Functional Recovery by Dobutamine Echocardiography, F-18 Deoxyglucose or <sup>99m</sup>Tc Sestamibi Nuclear Imaging in Patients with Chronic Myocardial Infarction

Randomized, Double-Blind Crossover Study to Investigate the Effects of Amlodipine and Isosorbide Mononitrate on the Time Course and Severity of Exercise-Induced Myocardial Stunning

Viability testing to guide myocardial revascularisation in patients with heart failure

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