Super-normal  retention in hibernating myocardium: an ex-vivo study using the failing human heart

Parodi, Oberdan; Maria, Renata De; Testa, Roberto; Vitali, Ettore; Ruffini, Livia; Gronda, Edoardo; Campolo, Jonica; Pellegrini, Alessandro

doi:10.1016/s0008-6363(98)00056-x

Cited by 3 publications

(10 citation statements)

References 35 publications

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“…Our results confirm the finding of enhanced thallium retention relative to resting flow and therefore support the clinical utility of late thallium imaging to identify myocardial viability. However, after 1 h of accumulation, thallium deposition in hibernating myocardium was nearly identical to that in the normally perfused remote myocardium and thus did not support the previous contention for supernormal thallium deposition in hibernating myocardium (19). Furthermore, these data suggest that within 1 h the assessment of thallium deposition has limited utility in differentiating viable, chronically dysfunctional myocardium with reduced resting flow (hibernating myocardium) from viable segments with normal perfusion (chronically stunned myocardium) (5).…”

mentioning

confidence: 58%

“…Matched reductions in thallium and flow were reported in 46 samples (49%), with matched normal levels in 20 samples (22%); however, in the remaining 27 samples (29%), they noted supernormal thallium retention. Despite the fact that these segments had reduced resting flow (0.43 Ϯ 0.29 vs. 0.97 Ϯ 0.28 ml⅐min Ϫ1 ⅐g Ϫ1 in normal), they had greater thallium retention than the most normal regions (107 Ϯ 16% vs. 81 Ϯ 14% in normal, P Ͻ 0.05; relative thallium/relative flow Ͼ 1.25) (19).…”

Section: Discussionmentioning

confidence: 92%

“…Before the present study, there was very little data regarding the relationship between thallium and blood flow in viable, chronically dysfunctional myocardium. An excellent study by Parodi et al (19) examined this relation in six patients with ischemic cardiomyopathy before cardiac transplantation. Myocardial blood flow was quantified with 99m Tc-pertechnetate-labeled albumin microspheres and compared with thallium administered 4 h before explantation.…”

Section: Discussionmentioning

confidence: 99%

“…This limitation is especially conspicuous in view of the important influence of hibernating myocardium on morbidity and mortality in patients with ischemic heart disease (1). The only data are from a small clinical trial in patients with end-stage ischemic heart disease undergoing cardiac transplantation (19). This study suggested that thallium deposition was supernormal in a number of samples with reduced perfusion, which could not be explained by redistribution (9,22), prolonged accumulation, or a delayed peak of maximum thallium uptake (19).…”

mentioning

confidence: 99%

“…The only data are from a small clinical trial in patients with end-stage ischemic heart disease undergoing cardiac transplantation (19). This study suggested that thallium deposition was supernormal in a number of samples with reduced perfusion, which could not be explained by redistribution (9,22), prolonged accumulation, or a delayed peak of maximum thallium uptake (19). Since these patients had end-stage heart disease requiring cardiac transplantation, most segments had increased fibrosis, and we hypothesized their findings could have been confounded by their assessment of thallium uptake.…”

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confidence: 99%

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Comparison of thallium deposition with segmental perfusion in pigs with chronic hibernating myocardium

Baldwa

Rana²,

Canty³

et al. 2008

American Journal of Physiology-Heart and Circulatory Physiology

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Baldwa S, Rana M, Canty JM, Fallavollita JA. Comparison of thallium deposition with segmental perfusion in pigs with chronic hibernating myocardium. Am J Physiol Heart Circ Physiol 295: H2522-H2529, 2008. doi:10.1152/ajpheart.00761.2008.-Viable, chronically dysfunctional myocardium with reduced resting flow (or hibernating myocardium) is an important prognostic factor in ischemic heart disease. Although thallium-201 imaging is frequently used to assess myocardial viability in patients with ischemic cardiomyopathy, there are limited data regarding its deposition in hibernating myocardium, and this data suggest that thallium retention may be supernormal compared with control myocardium. Accordingly, pigs (n ϭ 7) were chronically instrumented with a 1.5 mm Delrin stenosis on the proximal left anterior descending coronary artery (LAD) to produce hibernating myocardium. Four months later, severe anteroapical hypokinesis was documented with contrast ventriculography (wall motion score, 0.7 Ϯ 0.8; normal ϭ 3), and microsphere measurements confirmed reduced resting flow (LAD subendocardium, 0.78 Ϯ 0.34 vs. 0.96 Ϯ 0.24 ml⅐min Ϫ1 ⅐g Ϫ1 in remote; P Ͻ 0.001). Absolute deposition of thallium-201 and insulin-stimulated [18 F]-2 fluoro-2-deoxyglucose (FDG) were assessed over 1 h and compared with resting flow (n ϭ 704 samples). Thallium-201 deposition was only weakly correlated with perfusion (r 2 ϭ 0.20; P Ͻ 0.001) and was more homogeneously distributed (relative dispersion, 0.12 Ϯ 0.03 vs. 0.29 Ϯ 0.10 for microsphere flow; P Ͻ 0.01). Thus after 1 h relative thallium-201 (subendocardium LAD/remote, 0.96 Ϯ 0.16) overestimated relative perfusion (0.78 Ϯ 0.32; P Ͻ 0.0001) and underestimated the relative reduction in flow. Viability was confirmed by both histology and preserved FDG uptake. We conclude that under resting conditions, thallium-201 redistribution in hibernating myocardium is nearly complete within 1 h, with similar deposition to remote myocardium despite regional differences in flow. These data suggest that in this time frame thallium-201 deposition may not discriminate hibernating myocardium from dysfunction myocardium with normal resting flow. Since hibernating myocardium has been associated with a worse prognosis, this limitation could have significant clinical implications.

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confidence: 58%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Comparison of thallium deposition with segmental perfusion in pigs with chronic hibernating myocardium

Baldwa

Rana²,

Canty³

et al. 2008

American Journal of Physiology-Heart and Circulatory Physiology

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Regional mapping of myocardial hibernation phenotype in idiopathic end‐stage dilated cardiomyopathy

Lionetti

Matteucci

Ribezzo

et al. 2014

J Cellular Molecular Medi

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Myocardial hibernation (MH) is a well-known feature of human ischaemic cardiomyopathy (ICM), whereas its presence in human idiopathic dilated cardiomyopathy (DCM) is still controversial. We investigated the histological and molecular features of MH in left ventricle (LV) regions of failing DCM or ICM hearts. We examined failing hearts from DCM (n = 11; 41.9 ± 5.45 years; left ventricle-ejection fraction (LV-EF), 18 ± 3.16%) and ICM patients (n = 12; 58.08 ± 1.7 years; LVEF, 21.5 ± 6.08%) undergoing cardiac transplantation, and normal donor hearts (N, n = 8). LV inter-ventricular septum (IVS) and antero-lateral free wall (FW) were transmurally (i.e. sub-epicardial, mesocardial and sub-endocardial layers) analysed. LV glycogen content was shown to be increased in both DCM and ICM as compared with N hearts (P < 0.001), with a U-shaped transmural distribution (lower values in mesocardium). Capillary density was homogenously reduced in both DCM and ICM as compared with N (P < 0.05 versus N), with a lower decrease independent of the extent of fibrosis in sub-endocardial and sub-epicardial layers of DCM as compared with ICM. HIF1-α and nestin, recognized ischaemic molecular hallmarks, were similarly expressed in DCM-LV and ICM-LV myocardium. The proteomic profile was overlapping by ˜50% in DCM and ICM groups. Morphological and molecular features of MH were detected in end-stage ICM as well as in end-stage DCM LV, despite epicardial coronary artery patency and lower fibrosis in DCM hearts. Unravelling the presence of MH in the absence of coronary stenosis may be helpful to design a novel approach in the clinical management of DCM.

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Cardiac mapping and stem cell delivery for the damaged myocardium

Coletta¹,

Rosenthal²,

Costa³

2008

Expert Review of Cardiovascular Therapy

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Super-normal retention in hibernating myocardium: an ex-vivo study using the failing human heart

Cited by 3 publications

References 35 publications

Comparison of thallium deposition with segmental perfusion in pigs with chronic hibernating myocardium

Comparison of thallium deposition with segmental perfusion in pigs with chronic hibernating myocardium

Regional mapping of myocardial hibernation phenotype in idiopathic end‐stage dilated cardiomyopathy

Cardiac mapping and stem cell delivery for the damaged myocardium

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