Postextrasystolic Potentiation as a Predictor of Potential Myocardial Viability: Preoperative Analyses Compared With Studies After Coronary Bypass Surgery

Popio, Kenneth A.; Goblin, Richard; Bechtel, David; Levine, Jay A.

doi:10.1016/s0002-9149(77)80206-3

Cited by 184 publications

(36 citation statements)

References 22 publications

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“…The presence of contractile reserve indicates preserved myocardial perfusion and functional recovery after revascularization in chronic ischemic left ventricular dysfunction. 2,3,15,16 Methods for assessing the potentially viable myocardium include the use of postextrasystolic potentiation during left ventricular angiography, 17 the response of left ventricular contraction to an inotropic stimulus such as dobutamine, 2, 3, 15 evidence of uptake of thallium-201 in a dysfunctional region of myocardium, 3,6 positron emission tomography, 18 and intravenous myocardial contrast echocardiography (MCE). 19,20 Because of technical limitations, these methods cannot be applied in all hospitals.…”

Section: Discussionmentioning

confidence: 99%

Relation of ultrasonic tissue characterization with integrated backscatter to contractile reserve in patients with chronic coronary artery disease

Wang

Sun

et al. 2003

Clinical Cardiology

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SummaryBackground: Previous studies have shown that viable but stunned myocardium displays contractile reserve and exhibits cardiac cycle-dependent variations of integrated backscatter (CVIB), whereas infarcted myocardium does not.Hypothesis: This study was designed to clarify whether assessment of the acoustic properties of the myocardium can predict contractile reserve in patients with chronic coronary artery disease (CAD).Methods: In all, 21 patients with chronic CAD and 19 normal control subjects were studied. The magnitude of CVIB of the myocardium was measured in the basal and mid segment of the anterior septum and posterior wall of the left ventricle, using a real-time, two-dimensional integrated backscatter imaging system. The results were compared with the percent systolic wall thickening and the wall motion before and after revascularization. The wall motion was graded as normal, hypokinetic, or akinetic, and contractile reserve was considered present when an akinetic or hypokinetic segment improved after revascularization.Results: The average magnitude of CVIB was lower among dysfunctional segments of CAD than among normal segments of controls (3.73 ± 1.71 vs. 6.35 ± 0.69, p < 0.001). Of the 77 segments examined, 38 showed reversible dysfunction. Before revascularization, percent systolic wall thickening was similar among segments showing contractile reserve compared with those with persistent dysfunction myocardium (17.97 ± 8.41 vs. 16.83 ± 6.37%, p = 0.19), and the mean CVIB was significantly greater in segments with than in those without contractile reserve (4.73 ± 1.47 vs. 2.75 ± 1.31, p < 0.001). The CVIB above 3 dB before percutaneous transluminal coronary angioplasty predicted segments with con-

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Section: Discussionmentioning

confidence: 99%

Relation of ultrasonic tissue characterization with integrated backscatter to contractile reserve in patients with chronic coronary artery disease

Wang

Sun

et al. 2003

Clinical Cardiology

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“…More than 30 years ago, clinicians and surgeons started to notice that chronic myocardial dysfunction, present before coronary bypass, often improved after revascularization. [11][12][13][14] In pathophysiological terms, a severe reduction in coronary flow reserve is common in both stunning and hibernation, 4 and recovery of function in hibernating myocardium after coronary revascularization is paralleled by restoration of an adequate coronary flow reserve ( Figure 2). 15 Clinically, in different patients, similar degrees of LV dysfunction may be associated with large differences in the amount of viable myocardium, and even extreme degrees of wall thinning do not necessarily indicate the absence of viability.…”

Section: Myocardial Stunning and Hibernationmentioning

confidence: 99%

Stunning, Hibernation, and Assessment of Myocardial Viability

2008

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“…Contractility was not studied in the remaining four areas, as these areas were supplied by the left CX artery. Of the 20 preoperative areas which had abnormal perfusion, 16 demonstrated segmental contraction abnormalities, two had normal contraction and two were not studied. VOL Figure 4 is an example of marked improvement in contractility along the inferior heart border after vein graft surgery.…”

Section: Resultsmentioning

confidence: 99%

Improvement of myocardial perfusion and left ventricular function after coronary artery bypass grafting in patients with unstable angina.

Kolibash¹,

Goodenow²,

Bush³

et al. 1979

Circulation

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SUMMARY Changes in myocardial perfusion and left ventricular function were evaluated pre-and postoperatively (3-6 months) in 14 patients with unstable angina who underwent coronary artery bypass surgery. Perfusion was studied with intracoronary and intragraft injections of radiolabeled macroaggregated albumin particles. Of 20 abnormal perfusion areas identified preoperatively, 13 demonstrated improved perfusion postoperatively. Segmental analysis of the left ventriculogram demonstrated improved wall motion in 29 abnormally contracting segments; 18 normalized. Areas which showed improvement of left ventricular perfusion were invariably associated with improvement of left ventricular wall motion. Five patients showed improvement in perfusion and contraction in areas of apparent old myocardial infarction.Thirteen of the 14 patients had significantly less angina whether or not there was evidence of improved perfusion. However, only those patients who demonstrated improved perfusion had a significant improvement in their treadmill exercise tolerance postoperatively. Thus, patients with unstable angina have perfusion defects which may be reversed as a result of saphenous vein graft surgery. Reversal of these perfusion abnormalities results in improved left ventricular performance and better exercise tolerance postoperatively.CORONARY ARTERY BYPASS SURGERY has an important and widespread role in the treatment of coronary artery disease.1'3 Of particular significance to many investigators is the preoperative detection of ischemic, but viable, myocardium and the ultimate effects of revascularization upon improvement of left ventricular perfusion and function.4-5 Perhaps this problem is best exemplified in those patients with unstable angina who have poorly contracting areas of the ventricle which are being supplied by vessels with highly stenotic lesions. The recent reports of resting perfusion abnormalities in this group of patients6' 7 further raises the question whether these areas represent viable (reversibly damaged) myocardium or nonviable (irreversibly damaged) myocardium.Various techniques using intervention ventriculography have been used to identify potentially viable myocardium.8320 Another method used to differentiate between viable and nonviable myocardial tissue is the use of direct intracoronary instillation of radiolabeled, macroaggregated albumin particles.7 21-26Since these particles lodge in the coronary microcirculation, the presence of radioactivity throughout the myocardium has been equated with tissue viability. ticularly, the relationship of perfusion defects to segmental left ventricular contraction abnormalities and their potential for reversibility after coronary artery bypass surgery has not been demonstrated. If such perfusion defects do not always imply infarction, myocardial revascularization would be expected to correct the ischemia by improving blood flow, resulting in concomitant relief of angina and improvement of left ventricular performance. There have been relatively few studies exam...

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Postextrasystolic Potentiation as a Predictor of Potential Myocardial Viability: Preoperative Analyses Compared With Studies After Coronary Bypass Surgery

Cited by 184 publications

References 22 publications

Relation of ultrasonic tissue characterization with integrated backscatter to contractile reserve in patients with chronic coronary artery disease

Relation of ultrasonic tissue characterization with integrated backscatter to contractile reserve in patients with chronic coronary artery disease

Stunning, Hibernation, and Assessment of Myocardial Viability

Improvement of myocardial perfusion and left ventricular function after coronary artery bypass grafting in patients with unstable angina.

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