Sensitivity, specificity, and predictive accuracies of various noninvasive techniques for detecting hibernating myocardium

Bax, Jeroen J.; Poldermans, Don; Elhendy, Abdou; Boersma, Eric; Rahimtoola, Shahbudin H.

doi:10.1067/mcd.2001.109973

Cited by 216 publications

(158 citation statements)

References 99 publications

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“…15 Meta-analysis of 20 studies with 598 patients has shown a sensitivity of 93%. 4 The problem, however, is the lower specificity. Data from the meta-analysis demonstrated a specificity of 58%.…”

Section: Discussionmentioning

confidence: 99%

“…This lower specificity is observed not only with FDG imaging but also with other forms of radionuclide imaging. 4 The failure of viable myocardium to recover in function after revascularization may be related to various issues. One important issue, suggested recently by Yamaguchi et al, 5 is the presence of extensive LV remodeling.…”

Section: Discussionmentioning

confidence: 99%

“…Metaanalysis of 20 studies with 598 patients focusing on assessment of viability with metabolic imaging (with F18-fluorodeoxyglucose [FDG]) before revascularization demonstrated that the specificity of viability testing was lower than the sensitivity (93% versus 58%). 4 A lower specificity is partially related to the fact that patients with viable myocardium do not improve in function after revascularization. It has been suggested that a severely dilated LV (extensive remodeling) may not allow functional recovery after revascularization.…”

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Extensive Left Ventricular Remodeling Does Not Allow Viable Myocardium to Improve in Left Ventricular Ejection Fraction After Revascularization and Is Associated With Worse Long-Term Prognosis

et al. 2004

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Background-Extensive left ventricular (LV) remodeling may not allow functional recovery after revascularization, despite the presence of viable myocardium. Methods and Results-Seventy-nine consecutive patients with ischemic cardiomyopathy (left ventricle ejection fraction[LVEF] 29Ϯ7%) underwent surgical revascularization. Before revascularization, viability was assessed by metabolic imaging with F18-fluorodeoxyglucose and SPECT. LV volumes and LVEF were assessed by resting echocardiography. LVEF was re-assessed by echocardiography 8 to 12 months after revascularization. Three-year clinical follow-up (events: cardiac death, infarction, and hospitalization for heart failure) was also obtained. Forty-nine patients had substantial viability; 5 died before re-assessment of LVEF. Of the remaining 44 patients, 24 improved Ն5% in LVEF after revascularization, whereas 20 did not improve in LVEF. LV end-systolic volume was the only parameter that was significantly different between the groups (109Ϯ46 mL for the improvers versus 141Ϯ31 mL for the nonimprovers; PϽ0.05). The change in LVEF after revascularization was linearly related to the baseline LV end-systolic volume, with a higher LV end-systolic volume associated with a low likelihood of improvement in LVEF after revascularization. During the 3-year follow-up, the highest event-rate (67%) was observed in patients without viable myocardium with a large LV size, whereas the lowest event rate (5%) was observed in patients with viable myocardium and a small LV size. Intermediate event rates were observed in patients with viable myocardium and a large LV size (38%), and in patients without viable myocardium and a small LV size (24%). Conclusion-Extensive

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Extensive Left Ventricular Remodeling Does Not Allow Viable Myocardium to Improve in Left Ventricular Ejection Fraction After Revascularization and Is Associated With Worse Long-Term Prognosis

et al. 2004

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“…38 This report was later updated first in 2001 with the addition of further studies and again in 2007 including CMR data supporting the original findings and extending them. 95,96 In 2002, Allman et al 97 published a meta-analysis of 24 viability studies in 3,088 patients using SPECT with either thallium-201 or Tc-99m-based tracers, FDG imaging, and stress echocardiography. This analysis showed a 79% reduction in mortality for patients with evidence of myocardial viability on SPECT, FDG PET, or echo, who received revascularization vs those who did not.…”

Section: Meta-analyses Of Observational Studies Employing Tracer and mentioning

confidence: 99%

Noninvasive assessment myocardial viability: Current status and future directions

Allman

2013

Journal of Nuclear Cardiology

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Observations of reversibility of cardiac contractile dysfunction in patients with coronary artery disease and ischemia were first made more than 40 years ago. Since that time a wealth of basic science and clinical data has been gathered exploring the mechanisms of this phenomenon of myocardial viability and relevance to clinical care of patients. Advances in cardiac imaging techniques have contributed greatly to knowledge in the area, first with thallium-201 imaging, then later with Tc-99m-based tracers for SPECT imaging and metabolic tracers used in conjunction with positron emission tomography (PET), most commonly F-18 FDG in conjunction with blood flow imaging with N-13 ammonia or Rb-82 Cl. In parallel, stress echocardiography has made great progress also. Over time observational studies in patients using these techniques accumulated and were later summarized in several meta-analyses. More recently, cardiac magnetic resonance imaging (CMR) has contributed further information in combination with either late gadolinium enhancement imaging or dobutamine stress. This review discusses the tracer and CMR imaging techniques, the pooled observational data, the results of clinical trials, and ongoing investigation in the field. It also examines some of the current challenges and issues for researchers and explores the emerging potential of combined PET/CMR imaging for myocardial viability.

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“…; F-18 fluordezoksigliukozės PET -93 ir 58 proc. ; dobutamino echokardiografija ar MRT -81 ir 80 proc., atitinkamai (6). Radionuklidinių tyrimų jautrumas didesnis, bet specifiškumas mažesnis lyginant su echokardiografiniu tyrimu.…”

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Ischemic cardiomyopathy: possibilities of surgical treatment

Benetis¹,

Šimukauskienė²,

Jankauskienė

et al. 2007

Medicina

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trial). Šios studijos, palyginusios išeminės kardiomiopatijos medikamentinio ir chirurginio gydymo metodus, galbūt padės atsakyti į visus klinicistams rūpimus klausimus dėl gydymo taktikos pasirinkimo. Šiuo metu rekomenduojama vadovautis jau atliktų studijų naujausiais duomenimis.Išeminė širdies liga (IŠL) -pagrindinė kairiojo skilvelio (KS) sistolinės disfunkcijos priežastis išsi-vysčiusiose šalyse (1). Pagrįstas išeminio širdies nepakankamumo (ŠN) gydymas susideda iš medikamentinio gydymo, chirurginės revaskulizacijos (VJSOvainikinių jungčių suformavimo operacija) ir širdies persodinimo. Kai kuriems pacientams gali pagelbėti mechaniniai širdį pavaduojantys prietaisai, nors ieš-koma ir kitų naujų gydymo metodų (2). Nepaisant sparčiai tobulėjančių medikamentinio gydymo metodų, sunkaus ŠN medikamentinio gydymo baigtis yra bloga (3). Šio darbo tikslas -apžvelgti pastarųjų metų literatūrą, nagrinėjančią išeminės kardiomiopatijos (KMP) chirurginio gydymo galimybes bei įrodymais pagrįstas indikacijas šiam gydymo metodui.Revaskulizacija -pagrindinis įsisenėjusios išemi-nės KMP gydymo metodas. Reikėtų nuodugniai įver-tinti ir revaskulizacijos naudą atsižvelgiant į didelę operacijos riziką (4). Nors iki šiol atliktos retrospektyviosios studijos rodo geresnį pacientų po išeminės KMP revaskulizacijos išgyvenimą, lyginant su medikamentiniu tokių pacientų gydymu, kyla daug neaiš-kumų dėl optimalios gydymo strategijos. Todėl, atrenkant pacientus revaskulizacijai, labai svarbu įvertinti miokardo gyvybingumą. Terminas "gyvybingas miokardas" reiškia normaliai susitraukiantį ir hipokontraktilinį (priblokštą ar "žiemojantį") audinį (nors dažnai terminas "gyvybingas" siejamas su kontrakcijos atsiAdresas susirašinėti: A. Šimukauskienė, KMU Kardiologijos klinika,

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Sensitivity, specificity, and predictive accuracies of various noninvasive techniques for detecting hibernating myocardium

Cited by 216 publications

References 99 publications

Extensive Left Ventricular Remodeling Does Not Allow Viable Myocardium to Improve in Left Ventricular Ejection Fraction After Revascularization and Is Associated With Worse Long-Term Prognosis

Extensive Left Ventricular Remodeling Does Not Allow Viable Myocardium to Improve in Left Ventricular Ejection Fraction After Revascularization and Is Associated With Worse Long-Term Prognosis

Noninvasive assessment myocardial viability: Current status and future directions

Ischemic cardiomyopathy: possibilities of surgical treatment

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