medigraphic.com

2005, Number 2

Rev Mex Cardiol 2005; 16 (2)

Prevalence of myocardial viability in patients with ischemic cardiopathy and severe ventricular dysfunction

Francisco Martínez Baca-López, Jorge Rayo-Chávez, Samuel Guízar-Flores, Óscar Orihuela-Rodríguez, Guillermo Galindo-Mendoza, Emma Rosas Munive

Language: Spanish
References: 39
Page: 65-69
PDF size: 102.58 Kb.


ABSTRACT

Objective: To know the myocardial viability in patients with ischemic cardiopathy and severe ventricular dysfunction. Material and methods: 55 patients with a left ventricular ejection fraction ≤ 35% were studied. Myocardial viability was identified through a stress echocardiography with dobutamine at a low dosage. Results: Of the patients, 87% were men and 13% women with an age ranges from 39 to 84 years. The prevalence of myocardial viability was 53%. Patients were divided into two groups: group I (GI) with cellular viability and group II (GII) without cellular viability. There was not a significant statistical difference in localization of the infarct, functional class and number of injured vessels. Analysis of segments showed predominance of ventricular hypokinesis in GI with 53% vs 30% in GII, p: 0.0002002, OR: 1.83, IC 95% (1.31-2.55), ventricular akinesis predominated in GII with 36% vs 16% in GI, p: 0.0000304, OR: 0.46, IC 95% (0.32-0.68). In relation to the improvement of wall thickening and endocardial excursion, GI had 79% vs 45% in GII, p: 0.0000655, OR: 1.81, IC 95% (1.34-2.46). When the ventricular function at rest was compared with the one obtained with pharmacological stress, the systolic volume (FSV) had statistical significance; FSV was in GI of 114 mL vs 141 mL of GII p: 0.006. The interobserver concordance or Kappa was 0.69, and intraobserver concordance was 0.70. Conclusions: In this study 53% of patients with ischemic cardiopathy and severe ventricular dysfunction have a probability of recovering their ventricular function, since they showed myocardial viability. Cellular viability was associated with ventricular hypokinesis. The improvement of wall thickening and endocardial excursion > 5 mm are predictors of left ventricular function recovery if the patient is revascularized.


REFERENCES

  1. Senior R, Kaul S, Lahiri A. Myocardial viability on echocardiography predicts long term survival after revascularization in patients with ischemic congestive heart failure. J Am Coll Cardiol 1999; 33: 1848-1854.

  2. Galatro K, Chaudhry F. Prognostic implications of myocardial contractil reserve in patients with ischemic cardiomyopathy. Echocardiography 2000; 17(1): 61-67.

  3. Pasquet A, Lauer M, Williams M, Secknus M, Lytle B, Marwick T. Prediction of global left ventricular function after bypass surgery in patients with severe left ventricular dysfunction. Eur Heart J 2000; 21:125-136.

  4. Krahwinkel W, Ketteler T, Godke J, Wolftersz J, Ulbritch L, Krakau I, Gulker H. Dobutamine stress echocardiography. Eur Heart J 1997; 18(Suppl D): 9-15.

  5. Sonnenbllick E, Frisman W, Jemtel E. Dobutamine. New Engl J Med 1979; 300: 17-22.

  6. Piérard L, Berthe C, Albert A, Carlier J, Kulbertus E. Haemodynamic alterations during ischemia induced by dobutamine stress testing. Eur Heart J 1989; 10: 783-790.

  7. Barilla F, Gheorghiade M, Alam M, Khaja F, Goldstein S. Low dose dobutamine in patients with acute myocardial infarction identifies viable but not contractile myocardium and predicts the magnitude of improvement in wall motion abnormalities in response to coronary revascularization. Am Heart J 1991; 122: 1522-1531.

  8. Picano E, Ostojic M, Varga A, Sicari R, Djordjevic-Dikic A, Nedeljkovic I, Torres M. Combined low dose Dipyridamole-Dobutamine Stress Echocardiography to identify myocardial viability. Jam Coll Cardiol 1996; 27: 422-428.

  9. Pagley P, Beller G, Watson D, Gimple L, Ragosta M. Improved outcome coronary bypass surgery in patients with ischemic cardiomyopathy and residual myocardial viability. Circulation 1997; 96: 793-800.

  10. Pingitore A, Picano E, Colosso M, Reisenhofer B, Gigli G, Lucarini A, Petix M, Previtali M, Bigi R, Chiaranda G, Minardi G et al. The Atropine factor in pharmacologic stress echocardiography. J Am Cardiol 1996; 27: 1164-1170.

  11. Heus E, Schulz R. Characterization of hibernating and stunned myocardium. Eur Heart J 1997; 18(Suppl D): D102-D110.

  12. Pasquet A, Robert A, D’ohondt AM, Dion R, Melin JA, Vanoverschelde JL. Prognostic value of myocardial ischemia and viability in patient with chronic left ventricular ischemic dysfunction. Circulation 1999; 14: 141-148.

  13. Braunwald E, Kloner R, . The stunned myocardium: Prolonged postischemic ventricular dysfunction. Circulation 1982; 66: 1146-1149.

  14. Guéret P, Monin J, Chazuilleres A, Weber H, Duval A. Etude de la viabilité miocardique après infarctus récent par l’ echocardiographie sous dobutamine. Arch Mal Coeur 1995; 88(3): 13-17.

  15. Rahimtoola S. The hibernating myocardium. Am Heart J 1989; 117: 211-221.

  16. Sawada S. Dobutamine echocardiography for detection of viable myocardium in ischemic cardiomyopathy. Echocardiography 2000; 17(1): 69-77.

  17. Montalescot G, Faraggi M, Drobinski G, Le Gudulec G, Grosgogeat Y, Thomas D. Myocarde hibernant post infarctus. Arch Mal Coeur 1994; 87: 79-84.

  18. Previtali M. Myocardial viability in ischemic heart disease: new directions and perspectives. Ital Heart J 2001; 2: 93-99.

  19. Cigarroa C, De Filippi C, Brickner E, Alvarez L, Wait M, Grayburn P. Dobutamine stress echocardiography identifies hibernating myocardium and predicts recovery of left ventricular function after coronary revascularization. Circulation 1993; 88: 430-436.

  20. Marzullo P, Parodi O, Reinsenhofer B, Sambuceti G, Picano E, Distante A et al. Value of rest Thallium–201/Technetium –99 sestamibi scan and dobutamine echocardiography for detecting myocardial viability. Am J Cardiol 1993; 71: 166-172.

  21. Charney R, Schwinger M, Chun J, Cohen M, Nanna M, Menegus M, Spindola Franco H, Greenberg M. Dobutamine echocardiography and resting-redistribution Thallium-201 scintigraphy predicts recovery of hibernating myocardium after coronary revascularization. Am Heart J 1994; 128: 864-869.

  22. Perrone-Filardi P, Peace L, Prastaro M, Piscione F, Betocchi S, Squqme F, Vezzuto P et al. Dobutamine echocardiography predicts in improvement of hypoperfused dysfunctional myocardium after revascularization in patients with coronary artery disease. Circulation 1995; 91: 2556-2565.

  23. Arnese M, Cornel J, Salustri A, Maat A, Elhendy A, Reijs A, Cate F, Keane D et al. Prediction of improvement of regional left ventricular function after surgical revascularization. A comparison of low-dose dobutamine echocardiography with Thallium-201 single-photon emission computer tomography. Circulation 1995; 91: 2748-2752.

  24. De Filippi C, Willett DW, Irani W, Eichhorn E, Velasco C, Grayburn P. Comparison of myocardial contrast echocardiography and low dose dobutamine stress echocardiography in predicting recovery of left ventricular function after coronary revascularization in chronic ischemic heart disease. Circulation 1995; 92: 2863-2868.

  25. Vanoverschelde J, D¨Hondt A, Marwick T, Gerber B, Dekock M, Dion R, Wijns W, Melin J. Head - to- head comparison exercise-redistribution-reinjection Thallium single proton emission computer tomography and low dose of dobutamine echocardiography for prediction of reversibility of chronic left ventricular ischemic dysfunction. J Am Cardiol 1996; 28: 432-442.

  26. Afridi I, Main M, Grayburn P. Accuracy of dobutamine echocardiography for detection of myocardial viability in patients with an occluder left anterior descending coronary artery. J Am Cardiol 1996; 28: 455-459.

  27. Cwajg J, Cwajg E, Nagueh S, Zuo-Xiang-He, Qureshi U, Olmos L, Quiñones M, Verani M, Winters W, Zoghbi W. End diastolic wall thickness as a predictor of recovery of function in myocardial hibernation. J Am Coll Cardiol 2000; 35: 1152-61.

  28. Picano E, Sicari R, Landi P, Cortigiani L, Bigi R, Coletta C, Galati A, Heyman J. Prognostic value of myocardial viability in medically treated patients with global left ventricular dysfunction early after an acute uncomplicated myocardial infarction. A dobutamine steress echocardiographic study. Circulation 1998; 98: 1078-1084.

  29. Coversano A, Walsh J, Geltman E, Perez J, Bergmann S, Gropler S. Delineation of myocardial stunning and hibernation by positron emission tomography in advanced coronary artery disease. Am Heart J 1996; 131: 440-450.

  30. Becher H, Tiemann K, Scholosser T, Pohl C, Nanda N, Averkiou M, Powers J, Luderitz B. Improvement in endocardial border delineation using tissue harmonic imaging. Echocardiography 1998; 15: 511-517.

  31. Thomas J, Rubin D. Tissue harmonic imaging: away does it work ? J Am Soc Echocardiogr 1998; 11: 803-808.

  32. Ma L, Chen L, Gillam L, Waters D, Chen Ch. Nitroglycerin enhances the ability of dobutamine stress echocardiography to detected hibernating myocardium. Circulation 1997; 96: 3992-4001.

  33. Cornel J, Bax J, Elhendy A, Maat A, Kimman GJ, Geleijnse M, Rambaldi R, Boersma E et al. Bifasic response to dobutamine predicts improvement of global left ventricular function after surgical revascularization in patients. J Am Coll Cardiol 1998; 31: 1002-1010.

  34. Zoghbi W, Marwick T. Myocardial viability during dobutamine echocardiography predicts survival in patients with coronary artery disease and severe left ventricular systolic dysfunction. J Am Coll Cardiol 1998; 32: 921-6.

  35. Senior R, Glenville B, Basus S, Sridhara B, Anagnostu E, Standbridge R, Edmondson S et al. Dobutamine echocardiography and Thallium–201 imaging predict functional improvement after revascularization in severe ischemic left ventricular dysfunction. Br Heart J 1995; 74: 358-64.

  36. Cusick D, Bnow R, Chaudry F. Left ventricular apical thrombus and myocardial viability: A dobutamine stress echocardiography study. Echocardiography 2000; 17(6): 547-554.

  37. Meluzin J, Cerný J, Frélich M, Setetka F, Spinarová L, Popelova J, Stipal R. Prognostic value of the amount of dysfunctional but viable myocardium in revascularized patients with coronary artery disease and left ventricular dysfunction. J Am Coll Cardiol 1998; 32: 912-20.

  38. Sicari R, Picano E, Cortigiani L, Borges A, Varga A, Palagi C, Biggi R, Rossini R, Pasanisi E. Prognostic Value of Myocardial Viability Recognized by Low-Dose Dobutamine Echocardiography in Chronic Ischemic Left Ventricular Dysfunction. Am J Cardiol 2003; 92: 1263-1266.

  39. Afridi I, Grayburn PA, Panza JA, Oh JK, Zoghbi WA, Marwic TH. Myocardial viability during dobutamine echocardiography predicts survival in patients with coronary artery disease and severe left ventricular systolic dysfunction. J Am Coll Cardiol 1998; 4: 921-926.




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