Myocardial viability: recent developments in detection and clinical significance

Citation
W. Mazur et Sf. Nagueh, Myocardial viability: recent developments in detection and clinical significance, CURR OPIN C, 16(5), 2001, pp. 277-281
Citations number
22
Language
INGLESE
art.tipo
Review
Categorie Soggetti
Cardiovascular & Respiratory Systems
Journal title
CURRENT OPINION IN CARDIOLOGY
ISSN journal
0268-4705 → ACNP
Volume
16
Issue
5
Year of publication
2001
Pages
277 - 281
Database
ISI
SICI code
0268-4705(200109)16:5<277:MVRDID>2.0.ZU;2-O
Abstract
The long-term prognosis of patients with ischemic cardiomyopathy is highly variable, depending on the extent of myocardial viability and the success a nd completeness of the revascularization techniques used. Other important f actors include left ventricular function, extent of coronary artery disease (CAD), and patient age. Chronic left ventricular dysfunction in ischemic c ardiomyopathy is the result of a mixture of scarred as well as hibernating myocardium. In fact, most patients have both scarring and hibernation in di fferent regions. Transmural biopsies of dysfunctional segments reveals that recovery of function is inversely proportional to the extent of fibrosis a nd that endocardial fibrosis extending over 30% of the myocardial thickness precludes recovery of function. Nagueh et at [1] evaluated the relation of contractile reserve and thallium uptake in hibernating myocardium to myocardial structure in humans. The au thors found that segments with postoperative functional recovery had more w all thickening at low-dose dobutamine echocardiography (DE), higher thalliu m uptake, and less fibrosis (2.0 vs 28%) than those segments without recove ry. Also, segments with viability on DE had less fibrosis, less vimentin an d fibronectin, more glycogen, and higher thallium uptake, than those segmen ts without viability, Importantly, segments viable by single-photon emissio n computed tomography (SPECT) and DE had significantly less fibrosis (1%) t han those viable by only one of the two techniques. In this review, we disc uss recent developments in the detection of myocardial viability, including echocardiography, nuclear cardiac imaging, magnetic resonance imaging (MRI ), and other techniques. (C) 2001 Lippincott Williams & Wilkins, Inc.