Prognostic Value of Myocardial Viability in Medically Treated Patients With Global Left Ventricular Dysfunction Early After an Acute Uncomplicated Myocardial Infarction

Picaño, Eugenio; Sicari, Rosa; Landi, Patrizia; Cortigiani, Lauro; Bigi, Riccardo; Coletta, Claudio; Galati, Alfonso; Heyman, Joanna; Mattioli, Roberto; Previtali, Mario; Mathias, Wilson; Dodi, Claudio; Minardi, Giovanni; Lowenstein, Jorge; Seveso, Giovanni; Pingitore, Alessandro; Salustri, Alessandro; Raciti, Mauro

doi:10.1161/01.cir.98.11.1078

Cited by 166 publications

(79 citation statements)

References 25 publications

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“…Because the prognosis of patients with subendocardial infarction is better than that with transmural infarction, assessment of the transmurality of myocardial necrosis and ischemia is an important clinical issue for patients with acute myocardial infarction or with chronic myocardial ischemia (22,27). However, it has been difficult to make a diagnosis of subendocardial infarction by two-dimensional echocardiography.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of transmural distribution of viable muscle by myocardial strain profile and dobutamine stress echocardiography

Maruo

Nakatani²,

Jin³

et al. 2007

American Journal of Physiology-Heart and Circulatory Physiology

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bution of viable myocardium in the ischemic myocardium has not been quantified and fully elucidated. To address this issue, we evaluated transmural myocardial strain profile (TMSP) in dogs with myocardial infarction using a newly developed tissue strain imaging. TMSP was obtained from the posterior wall at the epicardial left ventricular short-axis view in 13 anesthetized open-chest dogs. After control measurements, the left circumflex coronary artery was occluded for 90 min to induce subendocardial infarction (SMI). Subsequently, latex microbeads (90 m) were injected in the same artery to create transmural infarction (TMI). In each stage, measurements were done before and after dobutamine challenge (10 g ⅐ kg Ϫ1 ⅐ min Ϫ1 for 10 min) to estimate transmural myocardial viability. Strain in the subendocardium in the control stage increased by dobutamine (from 53.6 Ϯ 17.1 to 73.3 Ϯ 21.8%, P Ͻ 0.001), whereas that in SMI and TMI stages was almost zero at baseline and did not increase significantly by dobutamine [from 0.8 Ϯ 8.8 to 1.3 Ϯ 7.0%, P ϭ not significant (NS) for SMI, from Ϫ3.9 Ϯ 5.6 to Ϫ1.9 Ϯ 6.0%, P ϭ NS for TMI]. Strain in the subepicardium increased by dobutamine in the control stage (from 23.9 Ϯ 6.1 to 26.3 Ϯ 6.4%, P Ͻ 0.05) and in the SMI stage (from 12.4 Ϯ 7.3 to 27.1 Ϯ 8.8%, P Ͻ 0.005), whereas that in the TMI stage did not change (from Ϫ1.0 Ϯ 7.8 to Ϫ0.7 Ϯ 8.3%, P ϭ NS). In SMI, the subendocardial contraction was lost, but the subepicardium showed a significant increase in contraction with dobutamine. However, in TMI, even the subepicardial increase was not seen. Assessment of transmural strain profile using tissue strain imaging was a new and useful method to estimate transmural distribution of the viable myocardium in myocardial infarction. myocardial infarction; strain; viability; echocardiography IT IS WELL KNOWN that myocardial contraction has transmural heterogeneity. Several experimental studies confirmed that the subendocardium contributes greater to overall myocardial thickening than the subepicardium (6, 25). On the other hand, when a reduction of coronary blood flow occurs, a severe reduction of perfusion and kinesis occurs in the subendocardium, but only a trivial reduction can be detected in the subepicardium (5, 31). After a long period of ischemia, myocardial necrosis progresses from the endocardium to the epicardium (8, 13).Myocardial strain reflects regional myocardial function. With the recent advancement of tissue Doppler echocardiography, myocardial strain can be obtained noninvasively (3, 33) and has been reported to be useful to quantify regional myocardial systolic function in ischemic heart disease (9, 11, 24, 29, 36). The recently developed myocardial strain imaging system provides us myocardial strain in each wall layer and shows its distribution in a form of transmural myocardial strain profile (TMSP; see Ref. 1). Thus combination of TMSP and dobutamine stress echocardiography (DSE), which has been used for the assessment of myocardial viability (18), is expected to demonstr...

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Section: Discussionmentioning

confidence: 99%

Evaluation of transmural distribution of viable muscle by myocardial strain profile and dobutamine stress echocardiography

Maruo

Nakatani²,

Jin³

et al. 2007

American Journal of Physiology-Heart and Circulatory Physiology

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“…[5][6][7] It has been shown that quantification of myocardial viability early after acute myocardial infarction provides a valuable tool for assessment of reversible myocardial LV dysfunction; moreover, the presence of substantial viable myocardium after infarction is associated with better outcome. 7 At present, sophisticated imaging modalities, including nuclear imaging (with single-photon emission computed tomography [SPECT] and positron emission tomography), dobutamine stress echocardiography, or MRI, are used for assessment of myocardial viability. 5,7 …”

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confidence: 99%

Viability Assessment With Global Left Ventricular Longitudinal Strain Predicts Recovery of Left Ventricular Function After Acute Myocardial Infarction

Mollema

Delgado

Bertini

et al. 2010

Circ: Cardiovascular Imaging

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Background-The extent of viable myocardial tissue is recognized as a major determinant of recovery of left ventricular (LV) function after myocardial infarction. In the current study, the role of global LV strain assessed with novel automated function imaging (AFI) to predict functional recovery after acute infarction was evaluated. Methods and Results-A total of 147 patients (mean age, 61Ϯ11 years) admitted for acute myocardial infarction were included. All patients underwent 2D echocardiography within 48 hours of admission. Significant relations were observed between baseline AFI global LV strain and peak level of troponin T (rϭ0.64), peak level of creatine phosphokinase (rϭ0.62), wall motion score index (rϭ0.52), and viability index assessed with single-photon emission computed tomography (rϭ0.79). At 1-year follow-up, LV ejection fraction was reassessed. Patients with absolute improvement in LV ejection fraction Ն5% at 1-year follow-up (nϭ70; 48%) had a higher (more negative) baseline AFI global LV strain (PϽ0.0001). Baseline AFI global LV strain was a predictor for change in LV ejection fraction at 1-year follow-up. A cutoff value for baseline AFI global LV strain of Ϫ13.7% yielded a sensitivity of 86% and a specificity of 74% to predict LV functional recovery at 1-year follow-up. Conclusions-AFI global LV strain early after acute myocardial infarction reflects myocardial viability and predicts recovery of LV function at 1-year follow-up. (Circ Cardiovasc Imaging. 2010;3:15-23.)

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“…It has been demonstrated that individuals submitted to myocardial revascularization can exhibit absence of parietal thickness in the infarcted area, however, the same can occur during exercise or any other form of stress. This fact explains the improvement in the functional capacity of infarcted patients who are submitted to revascularization, even without any improvement in the ventricular function at rest [11].…”

Section: Myocardial Viabilitymentioning

confidence: 94%

<![CDATA[<b>Stress echocardiography in coronary artery disease</b>]]>

Oliveira¹,

Barreto²,

Silva³

et al. 2004

Braz. j. cardiovasc. surg.

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Doppler echocardiography is a simple, fast and noninvasive method to identify abnormal regional or global left ventricular function. One could consider this non-invasive method to be the best approach of all imaging techniques.Stress echocardiography techniques are used for the diagnosis, risk stratification, prognosis and the study of myocardial viability in ischemic heart disease. There are many ways of subjecting the heart to stress for echocardiographic studies. For physically fit patients exercise stress testing using a treadmill or bicycle is employed and patients who are unable to exercise undergo pharmacological tests.Although accurate diagnosis and a high prognostic value are achieved with both methods, there are new techniques under study, including the utilization of echocardiographic microbubble contrast for endocardial edge evaluation and for myocardial perfusion studies. Descriptors: Stress. Echocardiography. Coronary disease.Resumo A ecodopplercardiografia é uma metodologia simples, rápida e não invasiva para identificar anormalidades regional e global da função do ventrículo esquerdo, podendo ser considerado o método não invasivo de maior aplicabilidade dentro das técnicas de imagem.A ecocardiografia sob estresse é utilizada para diagnóstico, estratificação de risco, prognóstico e avaliação da viabilidade miocárdica na doença arterial coronariana. Várias são as formas de se submeter o coração ao estresse para o estudo ecocardiográfico. Para indivíduos com capacidade física preservada, utiliza-se o teste com esteira ou bicicleta e para aqueles sem condições de se exercitar, são usados os testes farmacológicos.Apesar da boa acurácia diagnóstica e do valor prognóstico com os dois métodos já referidos, novas técnicas vêm sendo estudadas, como a utilização do contraste ecocardiográfico com microbolhas para avaliação das bordas do endocárdio e o estudo da perfusão miocárdica.Descritores: Estresse. Ecocardiografia. Coronariopatia. 56OLIVEIRA, JLM ET AL -Stress echocardiography in coronary artery disease Rev

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Prognostic Value of Myocardial Viability in Medically Treated Patients With Global Left Ventricular Dysfunction Early After an Acute Uncomplicated Myocardial Infarction

Cited by 166 publications

References 25 publications

Evaluation of transmural distribution of viable muscle by myocardial strain profile and dobutamine stress echocardiography

Evaluation of transmural distribution of viable muscle by myocardial strain profile and dobutamine stress echocardiography

Viability Assessment With Global Left Ventricular Longitudinal Strain Predicts Recovery of Left Ventricular Function After Acute Myocardial Infarction

<![CDATA[<b>Stress echocardiography in coronary artery disease</b>]]>

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