1
|
Shah DV, Kalekar DT, Gupta DA, Lamghare DP. Role of Late Gadolinium Enhancement in the Assessment of Myocardial Viability. Cureus 2022; 14:e22844. [PMID: 35382188 PMCID: PMC8977074 DOI: 10.7759/cureus.22844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Prior to any revascularization procedure for coronary artery disease, it is essential to identify viable myocardium which will likely benefit from it. In such a situation, delayed enhanced cardiac MRI is beneficial. Methods: Our study consisted of 50 patients with at least a one-month prior history of myocardial infarction (MI), abnormal findings on electrocardiography (ECG), and 2D-echocardiography (2D-ECHO), who were subjected to cardiac MRI performed on a 3T MRI machine. The MRI scans were evaluated for anatomical and especially functional characteristics of the heart, such as wall motion. On late gadolinium enhancement (LGE), the diseased segments were classified into two categories: < 50% LGE (viable) and > 50% LGE (non-viable). Results: Of the 378 diseased segments detected on LGE, 137 (36.2%) segments showed < 50% LGE and 241 (63.8%) segments showed > 50% LGE. The segments showing < 50% LGE showed normokinesia or hypokinesia, with none of the segments showing akinesia or dyskinesia, whereas the segments showing > 50% LGE showed akinesia or dyskinesia predominantly. This was found to be statistically highly significant (p-value < 0.001). Conclusion: Delayed enhanced-cardiac magnetic resonance (DE-CMR) imaging in patients with ischemic heart disease (IHD) helps evaluate the severity of the infarcted myocardium by classifying the diseased myocardium into viable and non-viable, as viable myocardium is more likely to regain functional recovery than non-viable myocardium. It also predicts the functional recovery of the myocardium after revascularization therapy.
Collapse
|
2
|
Abstract
The prevalence of heart failure (HF) is approximately 1-2% of the adult population in developed countries, rising to ≥ 10% among people over 70. The common symptoms of HF include shortness of breath, ankle swelling and fatigue, determined by a reduced cardiac output. Multimodality imaging is crucial to define HF etiology, determine prognosis and guiding tailored treatments. Echocardiography is the most widely used imaging modality and maintains a pivotal role in the initial diagnostic work-up and in the follow-up of HF patients. Cardiac magnetic resonance (CMR) may support the morpho-functional assessment provided by echocardiography when the acoustic window is limited or a gold standard evaluation is required. Furthermore, CMR is frequently used due to the unmatched capability to characterize myocardial structure. Coronary computed tomography angiography has become the non-invasive imaging of choice to diagnose or rule-out coronary artery disease, acquiring remarkable importance in the management of HF patients. Moreover, emerging capabilities of CT-based tissue characterization may be useful, especially when CMR is contraindicated. Finally, chest CT may contribute to precisely define the framework of HF patients, revealing new insight about cardiopulmonary pathophysiological interactions with potential high prognostic value.
Collapse
|
3
|
Bazylev VV, Shmatkov MG, P'ianzin AI. [Remote results of myocardial endovascular revascularization in patients with low ejection fraction]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2019; 25:159-165. [PMID: 31855213 DOI: 10.33529/angio2019403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Despite the present-day level of the development of cardiac surgery, a low left ventricular ejection fraction (LLVEF) is an important independent predictor of high complication rates and increased in-hospital mortality related to open surgical interventions. The method of myocardial endovascular revascularization is associated with the lowest rates of both intraoperative and early postoperative complications. However, percutaneous coronary intervention (PCI) does not always make it possible to perform anatomically complete myocardial revascularization. Comparisons of the remote results of anatomically complete and incomplete revascularization of the myocardium in the world literature seem to be extremely scarce and ambiguous, with a low ejection fraction in the majority of cases being an exclusion criterion. In order to elucidate these problems we carried out a prospective, single-centre study, including a total of 151 patients suffering from ischaemic heart disease with a left ventricular ejection fraction of less than 35%, who were subjected to myocardial endovascular revascularization. The patients were divided into 2 groups: those with complete (n=87) and incomplete (n=64) revascularization, followed by comparing the alterations in the echocardiographic parameters, assessing the incidence of repeat myocardial revascularization due to a relapse of the clinical course of angina pectoris, and the survival rate in the remote period. The obtained findings were suggestive of efficacy of both complete and incomplete endovascular revascularization of the myocardium in patients with a low left ventricular ejection fraction (LLVEF), with no statistically significant differences between the patients of both groups in the examined parameters revealed.
Collapse
Affiliation(s)
- V V Bazylev
- Federal Centre of Cardiovascular Surgery under the RF Ministry of Public Health, Penza, Russia
| | - M G Shmatkov
- Federal Centre of Cardiovascular Surgery under the RF Ministry of Public Health, Penza, Russia
| | - A I P'ianzin
- Federal Centre of Cardiovascular Surgery under the RF Ministry of Public Health, Penza, Russia
| |
Collapse
|
4
|
Löffler AI, Kramer CM. Myocardial Viability Testing to Guide Coronary Revascularization. Interv Cardiol Clin 2018; 7:355-365. [PMID: 29983147 DOI: 10.1016/j.iccl.2018.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Left ventricular dysfunction remains one of the best prognostic determinants of survival in patients with coronary artery disease. Revascularization has been shown to improve survival compared with medical therapy alone. Viability testing can help direct patients who will benefit the most from revascularization. Single-photon emission computed tomography, dobutamine stress echo, cardiac MRI, and PET imaging with F18-fluorodeoxyglucose are the most common modalities for assessing myocardial viability. Viability testing can help differentiate which patients benefit most from chronic total occlusion interventions.
Collapse
Affiliation(s)
- Adrián I Löffler
- Division of Cardiovascular Medicine, University of Virginia Health System, Box 800170, 1215 Lee Street, Charlottesville, VA 22908, USA
| | - Christopher M Kramer
- Division of Cardiovascular Medicine, University of Virginia Health System, Box 800170, 1215 Lee Street, Charlottesville, VA 22908, USA; Department of Radiology and Medical Imaging, Cardiovascular Imaging Center, University of Virginia Health System, Box 800170, 1215 Lee Street, Charlottesville, VA 22908, USA.
| |
Collapse
|
5
|
Nagueh SF, Chang SM, Nabi F, Shah DJ, Estep JD. Imaging to Diagnose and Manage Patients in Heart Failure With Reduced Ejection Fraction. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005615. [PMID: 28400485 DOI: 10.1161/circimaging.116.005615] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Sherif F Nagueh
- From the Methodist DeBakey Heart and Vascular Center, and Cardiovascular Imaging Institute Methodist Hospital, Houston, TX.
| | - Su Min Chang
- From the Methodist DeBakey Heart and Vascular Center, and Cardiovascular Imaging Institute Methodist Hospital, Houston, TX
| | - Faisal Nabi
- From the Methodist DeBakey Heart and Vascular Center, and Cardiovascular Imaging Institute Methodist Hospital, Houston, TX
| | - Dipan J Shah
- From the Methodist DeBakey Heart and Vascular Center, and Cardiovascular Imaging Institute Methodist Hospital, Houston, TX
| | - Jerry D Estep
- From the Methodist DeBakey Heart and Vascular Center, and Cardiovascular Imaging Institute Methodist Hospital, Houston, TX
| |
Collapse
|
6
|
Moreno PR, del Portillo JH. Isquemia miocárdica: conceptos básicos, diagnóstico e implicaciones clínicas. Tercera parte. REVISTA COLOMBIANA DE CARDIOLOGÍA 2017. [DOI: 10.1016/j.rccar.2016.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
7
|
Singh P, Sethi N, Kaur N, Kozman H. Revascularization in Severe Left Ventricular Dysfunction: Does Myocardial Viability Even Matter? CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 9:105-9. [PMID: 26157339 PMCID: PMC4485835 DOI: 10.4137/cmc.s18755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/25/2015] [Accepted: 03/31/2015] [Indexed: 11/05/2022]
Abstract
Left ventricular dysfunction is a powerful prognostic predictor in patients with coronary artery disease and increasing number of patients with CAD and ischemic left ventricular (LV) dysfunction is a major clinical problem. Congestive heart failure is a frequent complication which is associated with significant health care costs and two-third of cases have ischemic cardiomyopathy. In such patients, coronary revascularization can lead to symptomatic and prognostic improvement and reversal of LV remodeling which led to the concept of viable myocardium to select patients in whom recovery of LV function and improvement of prognosis will outweigh the risk of surgical revascularization. The aim of this review article is to understand the different modalities for assessing myocardial viability and clinical impact of revascularization in relation to the evidence of viability in patients with LV dysfunction.
Collapse
Affiliation(s)
- Pahul Singh
- Fellow in Cardiovascular disease, SUNY Upstate Medical University Syracuse, NY, USA
| | - Nishant Sethi
- Fellow in Cardiovascular disease, SUNY Upstate Medical University Syracuse, NY, USA
| | - Navneet Kaur
- Resident in Internal Medicine, SUNY Upstate Medical University Syracuse, NY, USA
| | - Hani Kozman
- Assistant Professor, Cardiovascular disease, SUNY Upstate Medical University Syracuse, NY, USA
| |
Collapse
|
8
|
Current state of the art cardiovascular MR imaging techniques for assessment of ischemic heart disease. Radiol Clin North Am 2014; 53:335-44. [PMID: 25726998 DOI: 10.1016/j.rcl.2014.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Cardiac magnetic resonance (CMR) imaging is increasingly being used to evaluate patients with known or suspected ischemic heart disease, because of its ability to acquire images in any orientation and the wide variety of sequences available to characterize normal and abnormal structure and function. Substantial improvements have been made in the hardware and software used to perform CMR, resulting in better and more consistent image quality. There has been a greater emphasis recently in developing and validating quantitative CMR techniques. This article reviews advances in CMR techniques for assessing cardiac function, myocardial perfusion, late gadolinium enhancement, and tissue characterization with T1 and T2 mapping sequences.
Collapse
|
9
|
Lim SP, Mc Ardle BA, Beanlands RS, Hessian RC. Myocardial Viability: It is Still Alive. Semin Nucl Med 2014; 44:358-74. [DOI: 10.1053/j.semnuclmed.2014.07.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
10
|
Husser O, Monmeneu JV, Bonanad C, Lopez-Lereu MP, Nuñez J, Bosch MJ, Garcia C, Sanchis J, Chorro FJ, Bodi V. Valor pronóstico de la isquemia miocárdica y la necrosis en pacientes con la función ventricular izquierda deprimida: un registro multicéntrico con resonancia magnética cardiaca de estrés. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2014.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
11
|
Husser O, Monmeneu JV, Bonanad C, Lopez-Lereu MP, Nuñez J, Bosch MJ, Garcia C, Sanchis J, Chorro FJ, Bodi V. Prognostic value of myocardial ischemia and necrosis in depressed left ventricular function: a multicenter stress cardiac magnetic resonance registry. ACTA ACUST UNITED AC 2014; 67:693-700. [PMID: 25172064 DOI: 10.1016/j.rec.2014.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 01/20/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES The incremental prognostic value of inducible myocardial ischemia over necrosis derived by stress cardiac magnetic resonance in depressed left ventricular function is unknown. We determined the prognostic value of necrosis and ischemia in patients with depressed left ventricular function referred for dipyridamole stress perfusion magnetic resonance. METHODS In a multicenter registry using stress magnetic resonance, the presence (≥ 2 segments) of late enhancement and perfusion defects and their association with major events (cardiac death and nonfatal infarction) was determined. RESULTS In 391 patients, perfusion defect or late enhancement were present in 224 (57%) and 237 (61%). During follow-up (median, 96 weeks), 47 major events (12%) occurred: 25 cardiac deaths and 22 myocardial infarctions. Patients with major events displayed a larger extent of perfusion defects (6 segments vs 3 segments; P <.001) but not late enhancement (5 segments vs 3 segments; P =.1). Major event rate was significantly higher in the presence of perfusion defects (17% vs 5%; P =.0005) but not of late enhancement (14% vs 9%; P =.1). Patients were categorized into 4 groups: absence of perfusion defect and absence of late enhancement (n = 124), presence of late enhancement and absence of perfusion defect (n = 43), presence of perfusion defect and presence of late enhancement (n = 195), absence of late enhancement and presence of perfusion defect (n = 29). Event rate was 5%, 7%, 16%, and 24%, respectively (P for trend = .003). In a multivariate regression model, only perfusion defect (hazard ratio = 2.86; 95% confidence interval, 1.37-5.95]; P = .002) but not late enhancement (hazard ratio = 1.70; 95% confidence interval, 0.90-3.22; P =.105) predicted events. CONCLUSIONS In depressed left ventricular function, the presence of inducible ischemia is the strongest predictor of major events.
Collapse
Affiliation(s)
- Oliver Husser
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain; Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany
| | | | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
| | | | - Julio Nuñez
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
| | - Maria J Bosch
- Servicio de Cardiología, Hospital La Plana, Vila-real, Spain
| | - Carlos Garcia
- Servicio de Cardiología, Hospital General de Castellón, Castellon, Spain
| | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
| | - Francisco J Chorro
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
| | - Vicente Bodi
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain.
| |
Collapse
|
12
|
Abstract
Magnetic resonance (MR) imaging plays an important role in evaluation of various aspects of myocardial infarction (MI). MR imaging is useful in establishing the diagnosis of acute MI, particularly in patients who present with symptoms of MI but outside the diagnostic time frame of altered cardiac enzyme levels or with clinical features of acute MI but without an angiographic culprit lesion. MR imaging is valuable in establishing a diagnosis of chronic MI and distinguishing this condition from nonischemic cardiomyopathies, mainly through use of delayed-enhancement patterns. MR imaging also provides clinicians with several prognostic indicators that enable risk stratification, such as scar burden, microvascular obstruction, hemorrhage, and peri-infarct ischemia. The extent and transmurality of scar burden have been shown to have independent and incremental prognostic power over a range of left ventricular function. The extent of scarring at MR imaging is an important predictor of successful outcome after revascularization procedures, and extensive scarring in the lateral wall indicates poor outcome after cardiac resynchronization therapy. Scar size at MR imaging is also a useful surrogate end point in clinical trials. Finally, MR imaging can be used to detect complications of MI, such as aneurysms, pericarditis, ventricular septal defect, thrombus, and mitral regurgitation. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.335125722/-/DC1.
Collapse
Affiliation(s)
- Prabhakar Rajiah
- Cardiothoracic Imaging Section, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | | | | |
Collapse
|
13
|
|
14
|
ten Kate GJR, Caliskan K, Dedic A, Meijboom WB, Neefjes LA, Manintveld OC, Krenning BJ, Ouhlous M, Nieman K, Krestin GP, de Feyter PJ. Computed tomography coronary imaging as a gatekeeper for invasive coronary angiography in patients with newly diagnosed heart failure of unknown aetiology. Eur J Heart Fail 2014; 15:1028-34. [DOI: 10.1093/eurjhf/hft090] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gert-Jan R. ten Kate
- Department of Cardiology; Thorax Centre Rotterdam; The Netherlands
- Department of Radiology; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Kadir Caliskan
- Department of Cardiology; Thorax Centre Rotterdam; The Netherlands
| | - Admir Dedic
- Department of Cardiology; Thorax Centre Rotterdam; The Netherlands
- Department of Radiology; Erasmus Medical Centre; Rotterdam The Netherlands
| | - W. Bob Meijboom
- Department of Cardiology; Thorax Centre Rotterdam; The Netherlands
| | - Lisan A. Neefjes
- Department of Cardiology; Thorax Centre Rotterdam; The Netherlands
- Department of Radiology; Erasmus Medical Centre; Rotterdam The Netherlands
| | | | | | - Mohammed Ouhlous
- Department of Radiology; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Koen Nieman
- Department of Cardiology; Thorax Centre Rotterdam; The Netherlands
- Department of Radiology; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Gabriel P. Krestin
- Department of Radiology; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Pim J. de Feyter
- Department of Cardiology; Thorax Centre Rotterdam; The Netherlands
- Department of Radiology; Erasmus Medical Centre; Rotterdam The Netherlands
| |
Collapse
|
15
|
Siefert AW, Rabbah JPM, Koomalsingh KJ, Touchton SA, Saikrishnan N, McGarvey JR, Gorman RC, Gorman JH, Yoganathan AP. In vitro mitral valve simulator mimics systolic valvular function of chronic ischemic mitral regurgitation ovine model. Ann Thorac Surg 2013; 95:825-30. [PMID: 23374445 DOI: 10.1016/j.athoracsur.2012.11.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 11/04/2012] [Accepted: 11/06/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study was undertaken to evaluate an in vitro mitral valve (MV) simulator's ability to mimic the systolic leaflet coaptation, regurgitation, and leaflet mechanics of a healthy ovine model and an ovine model with chronic ischemic mitral regurgitation (IMR). METHODS Mitral valve size and geometry of both healthy ovine animals and those with chronic IMR were used to recreate systolic MV function in vitro. A2-P2 coaptation length, coaptation depth, tenting area, anterior leaflet strain, and MR were compared between the animal groups and valves simulated in the bench-top model. RESULTS For the control conditions, no differences were observed between the healthy animals and simulator in coaptation length (p = 0.681), coaptation depth (p = 0.559), tenting area (p = 0.199), and anterior leaflet strain in the radial (p = 0.230) and circumferential (p = 0.364) directions. For the chronic IMR conditions, no differences were observed between the models in coaptation length (p = 0.596), coaptation depth (p = 0.621), tenting area (p = 0.879), and anterior leaflet strain in the radial (p = 0.151) and circumferential (p = 0.586) directions. MR was similar between IMR models, with an asymmetrical jet originating from the tethered A3-P3 leaflets. CONCLUSIONS This study is the first to demonstrate the effectiveness of an in vitro simulator to emulate the systolic valvular function and mechanics of a healthy ovine model and one with chronic IMR. The in vitro IMR model provides the capability to recreate intermediary and exacerbated levels of annular and subvalvular distortion for which IMR repairs can be simulated. This system provides a realistic and controllable test platform for the development and evaluation of current and future IMR repairs.
Collapse
Affiliation(s)
- Andrew W Siefert
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia 30332, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Mitral valve surgery in low ejection fraction, severe ischemic mitral regurgitation patients: should we repair them all? Curr Opin Cardiol 2012; 27:111-7. [PMID: 22274572 DOI: 10.1097/hco.0b013e32834fec29] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The optimal surgical treatment of chronic ischemic mitral regurgitation still is the subject of much debate in the surgical and cardiological communities. Although combined restrictive mitral annuloplasty and revascularization has demonstrated good results with regard to improvement of clinical status, low rates of recurrent mitral regurgitation and sustained left ventricular reverse remodeling, a survival benefit still has not been demonstrated. In addition, not all patients improve. Remaining issues in this field relate to identification of patients who will benefit from treatment, and to further improve and individualize treatment modalities. RECENT FINDINGS More data support the use of restrictive mitral annuloplasty and revascularization. New surgical techniques to improve mitral competence (posterior leaflet augmentation) and to promote left ventricular reverse remodeling in severely dilated hearts (addressing the subvalvular apparatus) are promising. Disease-specific annuloplasty rings have not (yet) proven additional value. New imaging modalities are available to assess the many components that constitute the complex pathophysiology of remodeling. SUMMARY The remaining challenge for cardiologists and surgeons is how to integrate data from different imaging techniques that assess mitral valve geometry and left ventricular size, geometry, function and potential functional recovery in order to individualize and optimize the surgical approach to patients with chronic ischemic mitral regurgitation.
Collapse
|
17
|
Imaging in heart failure: role of preoperative imaging and intraoperative transesophageal echocardiography for heart failure surgery. Int Anesthesiol Clin 2012; 50:55-82. [PMID: 22735720 DOI: 10.1097/aia.0b013e31825d8d80] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
18
|
van Slochteren FJ, Teske AJ, van der Spoel TIG, Koudstaal S, Doevendans PA, Sluijter JPG, Cramer MJM, Chamuleau SAJ. Advanced measurement techniques of regional myocardial function to assess the effects of cardiac regenerative therapy in different models of ischaemic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2012; 13:808-18. [DOI: 10.1093/ehjci/jes119] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
19
|
Oh JK, Velazquez EJ, Menicanti L, Pohost GM, Bonow RO, Lin G, Hellkamp AS, Ferrazzi P, Wos S, Rao V, Berman D, Bochenek A, Cherniavsky A, Rogowski J, Rouleau JL, Lee KL. Influence of baseline left ventricular function on the clinical outcome of surgical ventricular reconstruction in patients with ischaemic cardiomyopathy. Eur Heart J 2012; 34:39-47. [PMID: 22584648 DOI: 10.1093/eurheartj/ehs021] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
AIMS The Surgical Treatment for Ischemic Heart Failure (STICH) trial demonstrated no overall benefit when surgical ventricular reconstruction (SVR) was added to coronary artery bypass grafting (CABG) in patients with ischaemic cardiomyopathy. The present analysis was to determine whether, based on baseline left ventricular (LV) function parameters, any subgroups could be identified that benefited from SVR. METHODS AND RESULTS Among the 1000 patients enrolled, Core Lab measures of baseline LV function with adequate quality were obtained in 710 patients using echocardiography, in 352 using cardiovascular magnetic resonance, and in 344 using radionuclide imaging. The relationship between LV end-systolic volume index (ESVI), end-diastolic volume index, ejection fraction (EF), regional wall motion abnormalities, and outcome were first assessed only by echocardiographic measures, and then by 13 algorithms using a different hierarchy of imaging modalities and their quality. The median ESVI and EF were 78.0 (range: 22.8-283.8) mL/m2 and 28.0%, respectively. Hazard ratios comparing the randomized arms by subgroups of LVESVI and LVEF measured by echocardiography found that patients with smaller ventricles (LVESVI <60 mL/m2) and better LVEF (≥33%) may have benefitted by SVR, while those with larger ventricles (LVESVI >90 mL/m(2)) and lower LVEF (≤25%) did worse with SVR. Algorithms using all three imaging modalities found a weaker relationship between LV global function and the effects of SVR. The extent of regional wall motion abnormality did not influence the effects of SVR. CONCLUSIONS Subgroup analyses of the STICH trial suggest that patients with less dilated LV and better LVEF may benefit from SVR, while those with larger LV and poorer LVEF may do worse. Clinical Trial Registration #: NCT00023595.
Collapse
Affiliation(s)
- Jae K Oh
- Mayo Clinic, Gonda 6 South, 200 1st Street, SW, Rochester, MN, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Cortigiani L, Bigi R, Sicari R. Is viability still viable after the STICH trial? Eur Heart J Cardiovasc Imaging 2012; 13:219-226. [DOI: 10.1093/ejechocard/jer237] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
|
21
|
Mielniczuk LM, Beanlands RS. Imaging-Guided Selection of Patients With Ischemic Heart Failure for High-Risk Revascularization Improves Identification of Those With the Highest Clinical Benefit. Circ Cardiovasc Imaging 2012; 5:262-70; discussion 270. [DOI: 10.1161/circimaging.111.964668] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Lisa M. Mielniczuk
- From the Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Rob S. Beanlands
- From the Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| |
Collapse
|
22
|
Shah BN. Geometry or function for the prediction of prognosis following revascularization in ischaemic cardiomyopathy: beyond the ejection fraction. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:807; author reply 807-8. [PMID: 21816874 DOI: 10.1093/ejechocard/jer131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|