Prolonged Myocardial Hibernation Exacerbates Cardiomyocyte Degeneration and Impairs Recovery of Function After Revascularization

Schwarz, Ernst R.; Schoendube, Friedrich A.; Kostin, Sawa; N, Schmiedtke; Schulz, G; Buell, Udalrich; Messmer, Bruno J.; Morrison, John L.; Hanrath, Peter; Dahl, Juergen vom

doi:10.1016/s0735-1097(98)00041-2

Cited by 114 publications

(54 citation statements)

References 32 publications

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“…22,23) Similar results were recently reported by Bax, et al in patients with delayed revascularization and advanced cardiac remodeling. 24,25) In our study group we were not able to analyze the duration of systolic dysfunction before revascularization.…”

Section: Discussionsupporting

confidence: 83%

Contrast-Enhanced Magnetic Resonance and Thallium Scintigraphy in the Detection of Myocardial Viability A Prospective Comparative Study

et al. 2006

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SUMMARYThe aim of the present study was to prospectively compare contrast-enhanced magnetic resonance imaging (CE-MRI) with single-photon emission tomography using 201 Thallium chloride (SPECT Tl) in the detection of myocardial viability. Patients with chronic coronary artery disease and systolic dysfunction defined by an ejection fraction (EF) ≤ 45% were included. CE-MRI was performed 10-15 minutes after the administration of a gadolinium-based contrast agent using an Inversion Recovery Turbo FLASH (fast low-angle shot) sequence. A 4-hour rest redistribution protocol was used for SPECT Tl. Radionuclide ventriculography was used for the assessment of EF. Forty patients with an EF of 33.1 ± 7.7% were included. Thirty-two underwent a follow-up examination after revascularization. Comparison of viability assessment was performed in 1360 segments. Agreement was noted in 1065 (78.3%) segments, resulting in a kappa value of 0.336. Discrepancies were observed in 96 SPECT Tl viable segments that were described as nonviable according to CE-MRI and in 199 SPECT Tl nonviable segments that were viable in the CE-MRI study.In patients undergoing the follow-up examination, EF increased by 5.5 ± 7.3% (33.6 ± 8.6% to 39.2 ± 9.7%), but the relation between the amount of dysfunctional viable myocardium defined by both methods studied and the change in EF after revascularization was very weak and not statistically significant.Moderate agreement in the myocardial viability assessment between CE-MRI and SPECT Tl was observed. CE-MRI seems to be more accurate in identifying myocardial viability in inferior and inferolateral segments. We were unable to verify if either of the methods studied is useful for the prediction of EF improvement after revascularization. (Int Heart J 2006; 47: 521-532)

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Section: Discussionsupporting

confidence: 83%

Contrast-Enhanced Magnetic Resonance and Thallium Scintigraphy in the Detection of Myocardial Viability A Prospective Comparative Study

et al. 2006

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“…Occurrence of ongoing myocyte apoptosis in the chronic condition of cardiac hibernation, even though at very low rates, in a long-term perspective would certainly result in substantial cardiac cell loss, with timedependent reduction of the possibility to achieve full structural and functional recovery after adequate restoration of the coronary flow. In line with this speculation, in patients with multivessel coronary disease and myocardial hibernation undergoing coronary bypass surgery, the postoperative recovery in cardiac function was inversely proportional to the severity of the morphological changes 86 and enhanced in patients with a short history of hibernation, suggesting that early revascularization should be recommended to minimize the progression of cell degeneration in the hibernating myocardium and improve postoperative outcome. 86 …”

Section: Apoptosis and Hibernating Myocardiummentioning

confidence: 69%

“…In line with this speculation, in patients with multivessel coronary disease and myocardial hibernation undergoing coronary bypass surgery, the postoperative recovery in cardiac function was inversely proportional to the severity of the morphological changes 86 and enhanced in patients with a short history of hibernation, suggesting that early revascularization should be recommended to minimize the progression of cell degeneration in the hibernating myocardium and improve postoperative outcome. 86 …”

Section: Apoptosis and Hibernating Myocardiummentioning

confidence: 69%

Functional and clinical repercussions of myocyte apoptosis in the multifaceted damage by ischemia/reperfusion injury: old and new concepts after 10 years of contributions

Scarabelli

Gottlieb

2004

Cell Death Differ

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Ten years ago, the first finding of apoptotic cell death on the 'crime scene' of cardiac ischemia/reperfusion injury profoundly dismayed the scientific community. This observation jarred with the deeply rooted conviction that cardiac myocytes stoically 'break, but do not bend' in the fight against ischemia, instead of spontaneously accepting a peaceful demise for the greater good. Ten years later, a number of studies not only proved right the coexistence of necrosis and apoptosis on the ischemic battle field, but also implicated myocyte apoptosis in the pathogenesis of all the shapes and shades that cardiac ischemic injury can take on.

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“…[24][25][26][27] No major difference was observed in patient selection between previous studies and ours because the extent of coronary artery disease and the severity of LV dysfunction were similar. The timing of surgery after the viability assessment in patients with hibernating myocardium may influence the magnitude of the recovery in LV function.…”

Section: Discussionmentioning

confidence: 99%

“…Coronary bypass surgery was performed within 1 month of the viability assessment in the present study, so performing a more-delayed bypass operation may lose the patient the opportunity for LV function to recover due to the progressive structural degeneration with enhanced fibrosis. 27 The time difference between the CABG and the postoperative study is another explanation. Postoperative catheterization was performed 1 week to 6 months after CABG in the previous studies, [24][25][26][27] whereas a repeat study was done at 1-year postoperative in the present study.…”

Section: Discussionmentioning

confidence: 99%

Functional Recovery After Coronary Artery Bypass Grafting in Patients With Severe Left Ventricular Dysfunction and Preserved Myocardial Viability in the Left Anterior Descending Arterial Territory as Assessed by Thallium-201 Myocardial Perfusion Imaging

et al. 1999

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he prognosis of patients with coronary artery disease and severe left ventricular (LV) dysfunction is poor, unless significant functional recovery is gained with coronary revascularization to viable myocardium. [1][2][3][4][5][6][7][8] The purpose of the present study was to evaluate the clinical significance of myocardial viability in the territory supplied by the left anterior descending artery (LAD) in patients with severe LV dysfunction (ejection fraction (EF) ≤35%) who underwent coronary artery bypass grafting (CABG), because the prognostic and procedural significance of CABG to the LAD coronary artery was underscored recently. 9-11 Methods Study PatientsOne hundred consecutive patients, all who demonstrated of having myocardial viability in the LAD territory and who undergone CABG (66 men, 34 women, aged 42-85 years [mean, 66]) were studied retrospectively. Previous myocardial infarction and CABG had occurred in 66 and 3 patients, respectively. Left main coronary artery disease was found in 31 patients, 3-vessel disease in 44, 2-vessel disease in 23, and 1-vessel disease in 2. Written informed consent was obtained from all of the patients. EchocardiographyEchocardiographms were performed using a Toshiba SSH-65A (Tokyo, Japan) or an Aloka SSD-710 (Tokyo, Japan) with 2.5-3.75 MHz transducers. A complete Mmode and 2-dimensional study were performed and recorded on video tape for subsequent analysis. LV segmental wall motion abnormality and systolic wall thickJpn Circ J 1999; 63: 752 -758 (Received May 6, 1999; revised manuscript received June 24, 1999; accepted July 5, 1999 To evaluate the functional recovery after coronary bypass surgery in patients with severe left ventricular (LV) dysfunction (ejection fraction (EF) ≤35%), 100 consecutive patients with viable myocardium in the territory supplied by the left anterior descending artery (LAD) underwent coronary bypass grafting. In addition, cardiac catheterization and single-photon emission computed tomography (SPECT) perfusion imaging with thallium-201 were repeated 1-year postoperatively. Although 12 patients with severe LV dysfunction were preoperatively in a worse New York Heart Association functional class (3.1±0.7 vs 2.4±0.8; p<0.01), had a higher incidence of heart failure (10/12 vs 14/88; p<0.001) and had a worse LVEF (29±5 vs 61±14%; p<0.001) compared with 88 patients without severe LV dysfunction, the operative mortality was similar in the 2 groups (1/12 vs 2/88; p=NS). The postoperative NYHA functional class in the patients with severe LV dysfunction was similar to that in the patients without such dysfunction (1.6±0.7 vs 1.3±0.6; p=NS). In addition, the 1-year postoperative study revealed a significant improvement in the thallium defect score in both the LAD territory (1.7±1.2 to 0.7±1.0, p=0.01) and all the territories (5.2±2.2 to 3.2±1.9, p=0.002) in patients with severe LV dysfunction, whereas no improvement in defect score was found in either of these territories in those without severe LV dysfunction (LAD: 0.6±1.4 to 0.4±1.2, p=NS; All: 1.9±...

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Prolonged Myocardial Hibernation Exacerbates Cardiomyocyte Degeneration and Impairs Recovery of Function After Revascularization

Abstract: Hibernating myocardium exhibits time-dependent deterioration due to progressive structural degeneration with enhanced fibrosis. Early revascularization should be attempted to salvage the jeopardized tissue and improve postoperative outcome.

Cited by 114 publications

References 32 publications

Contrast-Enhanced Magnetic Resonance and Thallium Scintigraphy in the Detection of Myocardial Viability A Prospective Comparative Study

Contrast-Enhanced Magnetic Resonance and Thallium Scintigraphy in the Detection of Myocardial Viability A Prospective Comparative Study

Functional and clinical repercussions of myocyte apoptosis in the multifaceted damage by ischemia/reperfusion injury: old and new concepts after 10 years of contributions

Functional Recovery After Coronary Artery Bypass Grafting in Patients With Severe Left Ventricular Dysfunction and Preserved Myocardial Viability in the Left Anterior Descending Arterial Territory as Assessed by Thallium-201 Myocardial Perfusion Imaging

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