Predicting Benefit From Revascularization in Patients With Ischemic Heart Failure
2011; Lippincott Williams & Wilkins; Volume: 123; Issue: 4 Linguagem: Inglês
10.1161/circulationaha.109.903369
ISSN1524-4539
AutoresOrla Buckley, Marcelo F. Di Carli,
Tópico(s)Cardiac Valve Diseases and Treatments
ResumoHomeCirculationVol. 123, No. 4Predicting Benefit From Revascularization in Patients With Ischemic Heart Failure Free AccessBrief ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessBrief ReportPDF/EPUBPredicting Benefit From Revascularization in Patients With Ischemic Heart FailureImaging of Myocardial Ischemia and Viability Orla Buckley, MD and Marcelo Di Carli, MD Orla BuckleyOrla Buckley From the Clinical Fellow of the Department of Noninvasive Cardiovascular Imaging (O.B.), Chief of the Division of Noninvasive Cardiovascular Imaging Program and Chief of Nuclear Medicine and Molecular Imaging (M.D.C.), Brigham and Women's Hospital, Boston, MA. Dr Buckley is currently affiliated with Adelaide, Meath, and the National Children's Hospital, Tallaght, Dublin 24, Ireland. and Marcelo Di CarliMarcelo Di Carli From the Clinical Fellow of the Department of Noninvasive Cardiovascular Imaging (O.B.), Chief of the Division of Noninvasive Cardiovascular Imaging Program and Chief of Nuclear Medicine and Molecular Imaging (M.D.C.), Brigham and Women's Hospital, Boston, MA. Dr Buckley is currently affiliated with Adelaide, Meath, and the National Children's Hospital, Tallaght, Dublin 24, Ireland. Originally published1 Feb 2011https://doi.org/10.1161/CIRCULATIONAHA.109.903369Circulation. 2011;123:444–450Case History: A 62-year-old male with a history of hypertension and coronary artery disease with prior stenting to the left circumflex artery presented with chest pain. Echocardiography on admission demonstrated a globally reduced ejection fraction of 10% to 15% with regional wall-motion abnormality consistent with prior anterior and inferolateral infarction. End-diastolic volume of the left ventricle (LV) was 210 mL. Coronary angiography showed evidence of multivessel disease, with 100% occlusion of the left anterior descending coronary artery, 70% in-stent restenosis of the left circumflex artery, and 90% stenosis of the posterior descending artery. To evaluate for the presence of ischemia, the patient underwent a rest-stress myocardial perfusion imaging study, which showed a large area of moderate ischemia throughout the mid left anterior descending coronary artery territory. In addition, there was a small area of scar in the proximal left circumflex artery territory (Figure 1). Clinical discussion ensued as to whether this patient would benefit from bypass surgery or percutaneous revascularization.Download figureDownload PowerPointDownload figureDownload figureDownload PowerPointFigure 1. A, Stress-rest rubidium 82 (82Rb) myocardial perfusion PET/computed tomography study in corresponding short-axis (SA; top), horizontal long-axis (HLA; middle), and vertical long-axis (VLA; bottom) slices. The LV is severely dilated (end-diastolic volume of 335 mL), and LV ejection fraction is reduced at 18%. There is a large and severe perfusion defect throughout the anterior and anteroseptal walls and the LV apex, consistent with extensive stress-induced ischemia throughout the left anterior descending coronary artery territory. In addition, there is an associated small area of fixed perfusion deficit that involves the basal inferior and inferolateral walls, consistent with scar in the left circumflex artery territory indicated. B, Three-dimensionally rendered reconstructions of the LV demonstrating the quantitative extent and severity of perfusion deficit (blackout region) and the magnitude of stress-induced ischemia or defect reversibility (pink).IntroductionProspective identification of patients with ischemic heart failure who may benefit from high-risk revascularization remains a clinical challenge. The prediction of functional, symptomatic, and survival benefit depends on multiple factors, including the quality of the target vessels for revascularization, the magnitude of myocardial ischemia and viability, the degree of LV remodeling after myocardial infarction (MI), and other clinical factors.1,2 This Clinician Update reviews the optimal patient selection for referral for viability assessment, the rationale for noninvasive assessment of myocardial ischemia and viability, the strengths and weaknesses of the available imaging modalities, the impact of LV remodeling on recovery of LV function and survival, and the optimal time frame from presentation to noninvasive assessment and revascularization.When Is Assessment of Myocardial Ischemia and Viability Clinically Important?LV function is a well-established and powerful predictor of prognosis after MI. The occurrence of severe LV systolic dysfunction after MI, especially if associated with heart failure, is associated with very poor survival. Differentiation between LV dysfunction caused by infarction, necrosis, and scar tissue formation versus LV dysfunction due to ischemic but viable myocardium has important implications. Identification of the latter group of patients with these potentially reversible causes of heart failure may be associated with substantial survival benefit, symptomatic improvement, and improved LV function with revascularization.3,4Determination of the risk-versus-benefit ratio from high-risk revascularization in patients with ischemic LV dysfunction is not always clear-cut. Multiple factors are known to influence clinical outcomes. The clinical decision to revascularize is generally straightforward in patients with severe LV dysfunction, severe anginal symptoms, mild LV remodeling, adequate target vessels for revascularization, and minimal comorbidities.3 In this patient group, clinical improvement has not always been associated with an improvement in LV function.5 Survival benefit in these patients likely results from revascularization of myocardial territories in jeopardy, thereby preventing cell death and ultimately adverse clinical events. Consequently, evaluation of stress-induced ischemia is essential to define the magnitude of potentially salvageable, viable but ischemic myocardium.Decisions regarding referral for high-risk revascularization are more difficult in the elderly with several comorbidities (predominantly heart failure symptoms) and prior revascularization, combined with low ejection fraction and advanced LV remodeling. In this frail patient group, the absence of anginal symptoms has often been associated with the absence of myocardial ischemia or viability and a lower likelihood of clinical benefit from revascularization. However, dyspnea may be an anginal equivalent in many of these patients, and may reflect the presence of large areas of ischemia, hibernation, or stunning rather than scar. Indeed, clinically significant residual viability may be found in a significant number of patients with predominantly heart failure symptoms.6 Despite the higher clinical risk, the presence of ischemia or viability in these patients has been associated with improved outcomes after revascularization.7 Thus, noninvasive assessment of myocardial ischemia and viability may provide crucial information for the identification of patients who will benefit from high-risk revascularization.Noninvasive Imaging Approaches to Assess Myocardial Ischemia and ViabilityNuclear medicine techniques such as thallium 201 (201Tl) or technetium Tc 99m (99mTc) single photon emission computed tomography (SPECT) and fluorodeoxyglucose F 18 (18F-FDG)–positron emission tomography (PET)/computed tomography evaluate cell membrane integrity and myocyte metabolism and thus cell viability. After injection, the initial myocardial uptake of 201Tl is dependent on myocardial blood flow; however, the subsequent retention of 201Tl 3 to 4 hours after injection is an active, energy-requiring process that is a function of cell membrane integrity and tissue viability.8 Like 201Tl, the uptake and retention of 99mTc–labeled agents require an intact cell membrane. The latter approach is comparable to 201Tl except in areas of severe perfusion deficit, where it tends to underestimate the degree of viability.9 The dependence of glucose for energy metabolism by ischemic myocardium is the rationale for the use of [18F]-FDG PET/computed tomography for viability assessment. Dysfunctional myocardium with preserved glucose uptake denotes the presence of viability and the potential for recovery after revascularization.The augmentation of contractility (so-called contractile reserve) in response to dobutamine stress is the basis for the use of stress echocardiography. Dysfunctional myocardium that is able to show a transient improvement in systolic function in response to dobutamine (contractile reserve) is considered viable; conversely, a lack of improvement in regional systolic function with dobutamine is considered to reflect the absence of potentially reversible dysfunctional myocardium.10 The contractile reserve in response to dobutamine can also be investigated with cardiac magnetic resonance (CMR; Figure 2).Download figureDownload PowerPointFigure 2. Cine mid short-axis magnetic resonance imaging images at baseline and in response to increasing doses of dobutamine. The baseline images demonstrate mild LV dilatation with moderate inferior and inferolateral wall hypokinesis, which improves at 20 μg · kg−1 · min−1 (low dose) of dobutamine and then worsens at 40 μg · kg−1 · min−1 (high dose), illustrating the so-called biphasic response that reflects viable but ischemic myocardium in the posterior descending territory. Full-motion cines can be viewed in the online-only Data Supplement.Direct imaging of myocardial scar forms the basis of gadolinium-enhanced CMR. Gadolinium is an extracellular contrast agent that accumulates in areas of myocardial scar due to the greatly expanded extracellular space. With this approach, myocardial scar shows as bright areas (white) on CMR (so-called late gadolinium enhancement; Figure 3). Unlike nuclear medicine techniques, the increased spatial resolution of CMR allows delineation of the transmural extent of scar tissue. The addition of dobutamine stress imaging to CMR may help differentiate ischemic from nonischemic cardiomyopathy and may refine predictions of functional recovery after revascularization, especially in areas with nontransmural scar.11 Similar to late gadolinium enhancement with CMR, cardiac computed tomography can also be used for direct imaging of myocardial scar.12,13 Cardiac computed tomography has submillimeter spatial resolution, but with these thin slices, contrast resolution is limited by low signal-to-noise ratio.Download figureDownload PowerPointFigure 3. Example of stress, rest, and delayed CMR images in a man with known coronary artery disease, prior MI, and stenting of the left anterior descending coronary artery. Images represent mid short-axis views of the LV. The stress images demonstrate extensive anterior, anterolateral, and septal subendocardial hypoperfusion (arrows). The rest images demonstrate residual areas of subendocardial perfusion deficit in the anterolateral and septal walls, which match the area of gadolinium enhancement on the delayed images. This study is consistent with a large area of prior MI throughout the left anterior descending coronary artery territory with evidence of some residual stress-induced peri-infarct ischemia.Relative Accuracy of Methods for Viability AssessmentUncertainty persists concerning the relative accuracies of methods for predicting recovery of LV function and outcomes after revascularization. Available data suggest that both SPECT and especially PET are highly sensitive (85% to 90% [sensitivity of PET] versus 70% to 75% [sensitivity of SPECT]), with a higher negative predictive value than with dobutamine echocardiography. Dobutamine echocardiography has the advantage of a higher specificity and a higher positive predictive accuracy than the scintigraphic methods (Figure 4).14,15 Although the experience with contrast-enhanced magnetic resonance imaging is more limited, recent results suggest that it offers similar predictive accuracies as those seen with dobutamine echocardiography.16Download figureDownload PowerPointFigure 4. Relative sensitivities and specificities of the modalities currently used for myocardial ischemia and viability assessment are listed. Sensitivity: P<0.05 PET better vs others. Specificity: P<0.05 Echocardiography (Echo) vs others. Pts indicates patients; st, number of studies. Graph from Schinkel et al.15Selecting the Approach for Assessment of Myocardial ViabilityPredictive accuracies (Figure 4; Table) are influenced by the level of local expertise.14,15 It remains unclear whether some patient subsets are better evaluated by a particular test or perhaps a combination of tests (Table).11,14,17,18 The reported diagnostic accuracies of each of these imaging approaches to predict recovery of LV function have been highly variable. The reasons for these highly variable results are not well understood. However, because the probability of improvement in LV function after revascularization is multifactorial, it is likely that relying on any 1 of these indices of tissue viability or its absence in isolation will lead to suboptimal clinical results.2 Indeed, it is now evident that other factors, including the presence and magnitude of stress-induced ischemia, the stage of cellular degeneration within viable myocytes, the degree of LV remodeling, the timing and success of revascularization procedures, and the adequacy of the target coronary vessels, can affect the functional outcome after revascularization. Thus, a combination of tests that provide complementary insights regarding cellular viability may be beneficial for more accurate predictions of functional recovery in high-risk patients. Evaluation of the probability of functional recovery after revascularization can be significantly enhanced by the use of predictive models that incorporate clinical and imaging data.1Table. Relative Strengths and Weakness of the Different Modalities Available for Noninvasive Assessment of Myocardial ViabilityParameter[18F]-PET CTSPECT (Tc99m MIBI)Dobutamine EchoCMRSensitivity and specificitySensitivity: 88%*Sensitivity: 83%*Sensitivity: 84%*Dobutamine CMR:Specificity: 73%*Specificity: 69%*Specificity: 81%*Sensitivity: 88%†Specificity: 87%†Delayed-enhancement CMR‡:Sensitivity: 96%‡Specificity: 84%‡Higher sensitivity for detection of subendocardial scar11ProtocolStress/rest protocol safely performed (pharmacological)Stress/rest protocol safely performed (physiological or pharmacological)Stress/rest protocol safely performed (pharmacological)Pharmacological stress can be performed (although with restricted monitoring capabilities)Length of study<30-min study for stress/rest protocol, up to 4 h for FDG viability protocol4-h study60-min study90-min examinationPatient issuesClaustrophobia can be an issuePatient can lie semisupine, which can be helpful for patients unable to lie flat owing to shortness of breathAcoustic windows can be limited in the obese and those with COPDClaustrophobia can be problematicPotential problemsGlucose manipulation can be challenging in diabetic patientsGadolinium may be contraindicated in certain patients[18F]FDG-PET CT indicates fluorodeoxyglucose F 18 positron emission tomography/computed tomography; SPECT (Tc99m MIBI), single photon emission computed tomography (technetium Tc 99m); Echo, echocardiography; and COPD, chronic obstructive pulmonary disease.*From a meta-analysis by Bax et al.14†From Baer et al.17‡From Kuhl et al.18Applying Myocardial Viability Information to Management DecisionsThe demonstration of viable myocardium in patients with coronary artery disease and LV dysfunction consistently identifies patients with particularly poor prognosis when treated with medical therapy alone. These patients have improved survival and fewer symptoms with prompt revascularization.19 These findings have been confirmed with nuclear testing or echocardiography.7 Indeed, a recent meta-analysis by Allman et al7 reported on the pooled results of 24 studies that documented long-term patient outcomes after viability imaging by SPECT, PET, or dobutamine echocardiography in 3088 patients (2228 men, 860 women) with a mean ejection fraction of 32±8% and follow-up for 25±10 months. In patients with evidence of viable myocardium, a strong association was present between revascularization and improved outcomes, particularly in patients with severe LV dysfunction. There was no apparent benefit for revascularization over medical therapy in the absence of viability. There was also a trend toward higher death and nonfatal event rates with revascularization, which could reflect the higher procedural risk for patients with severe LV dysfunction associated with the revascularization itself in the absence of a balancing clinical benefit. Multivariate modeling (meta-regression) of pooled data in patients with viable myocardium demonstrated that as the severity of LV dysfunction increases and the LV ejection fraction decreases, the potential benefit (reduction in risk of death and nonfatal events) associated with revascularization increases. Thus, despite the increased risk of revascularization with worsening LV dysfunction, noninvasive imaging evidence of preserved viability may suggest a net clinical benefit.Additional Factors That Affect Clinical Outcomes After RevascularizationDegree of LV RemodelingMI, especially an MI that is large and transmural, can produce alterations in both the infarcted and noninfarcted regions that result in changes in LV architecture known as LV remodeling. In addition to the early thinning and elongation that occur in the infarcted myocardium (infarct expansion), there are secondary changes in the noninfarcted zone. These include a time-dependent increase in the end-diastolic length of viable myocytes that contributes to the overall process of LV enlargement. Although this acute increase in cavity size tends to maintain pump function, this process usually leads to progressive ventricular dilation, heart failure, and decreased survival.Increased LV volumes and cavity size predict poor outcome in patients with ischemic cardiomyopathy undergoing revascularization. Echocardiography (2- and 3-dimensional) and CMR imaging can accurately determine LV volumes. LV end-diastolic dimension greater than or equal to twice normal (≥70 mm) predicts poor prognosis after revascularization because it indicates the presence of multiple segments of scarred and nonviable myocardium20,21; once this degree of LV remodeling and these ventricular dimensions have been reached, even if viability is documented, revascularization has not been shown to be associated with clinical benefit.22,23 More recent data from the STICH trial (Surgical Treatment for Ischemic Heart Failure)24 demonstrated that surgical revascularization reduced LV end-systolic volume by only 6% from baseline, which suggests a modest reverse-remodeling effect.Timeliness of RevascularizationThere is mounting evidence that myocardial hibernation represents an incomplete adaptation to ischemia. The precarious balance between impaired perfusion and viability cannot be maintained indefinitely. Cellular degeneration and eventually myocardial necrosis will occur if blood flow is not increased in a timely manner. The severity of morphological degeneration appears to correlate with the timing and degree of functional recovery after revascularization.25,26 Thus, the early hazard associated with the presence of ischemic but viable tissue suggests that prompt revascularization may provide the greatest survival benefit.ConclusionsDecisions about revascularization in patients with heart failure symptoms and LV dysfunction are influenced by factors that do not always correlate with documented LV functional improvement. Choice of imaging modality depends on local expertise and patient-specific factors. A combination of modalities may be required. The incorporation of an assessment of ischemia with viability assessment can provide valuable additional information for patient selection for revascularization.Follow-Up of CaseIn light of the dilated LV, severe LV dysfunction, and potential surgical morbidity and mortality, our patient received percutaneous therapy, with successful stenting of the left anterior descending and right coronary arteries. Three months after percutaneous intervention, the patient has no anginal symptoms and has New York Heart Association class 1 heart failure despite an ejection fraction of 15% to 20%.AcknowledgmentsRaymond Kwong, MD, MPH, Division of Cardiology and Director of Cardiac MRI, Brigham and Women's Hospital, provided Figure 2 and Movie I for this article.DisclosuresDr Di Carli receives unrestricted research grants from Siemens, GE, Bracco, and Astellas. Dr Buckley reports no conflicts.FootnotesThe online-only Data Supplement is available with this article at http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.109.903369/DC1.Correspondence to Orla Buckley, MD, Attending Radiologist, Adelaide, Meath, and the National Children's Hospital, Tallaght, Dublin 24, Ireland. Email: orla.[email protected]ie.References1. Beanlands RS, Ruddy TD, deKemp RA, Iwanochko RM, Coates G, Freeman M, Nahmias C, Hendry P, Burns RJ, Lamy A, Mickleborough L, Kostuk W, Fallen E, Nichol G. Positron emission tomography and recovery following revascularization (PARR-1): the importance of scar and the development of a prediction rule for the degree of recovery of left ventricular function. J Am Coll Cardiol. 2002; 40:1735–1743.CrossrefMedlineGoogle Scholar2. Di Carli MF, Hachamovitch R, Berman DS. The art and science of predicting postrevascularization improvement in left ventricular (LV) function in patients with severely depressed LV function. J Am Coll Cardiol. 2002; 40:1744–1747.CrossrefMedlineGoogle Scholar3. Baker DW, Jones R, Hodges J, Massie BM, Konstam MA, Rose EA. Management of heart failure, III: the role of revascularization in the treatment of patients with moderate or severe left ventricular systolic dysfunction. JAMA. 1994; 272:1528–1534.CrossrefMedlineGoogle Scholar4. Di Carli MF, Hachamovitch R. New technology for noninvasive evaluation of coronary artery disease. Circulation. 2007; 115:1464–1480.LinkGoogle Scholar5. Samady H, Elefteriades JA, Abbott BG, Mattera JA, McPherson CA, Wackers FJ. Failure to improve left ventricular function after coronary revascularization for ischemic cardiomyopathy is not associated with worse outcome. Circulation. 1999; 100:1298–1304.LinkGoogle Scholar6. Cleland JG, Pennel D, Ray S, Murray G, MacFarlane P, Cowley A, Coats A, Lahiri AThe CHRISTMAS Study Steering Committee and Investigators. The carvedilol hibernation reversible ischaemia trial: marker of success (CHRISTMAS). Eur J Heart Fail. 1999; 1:191–196.CrossrefMedlineGoogle Scholar7. Allman KC, Shaw LJ, Hachamovitch R, Udelson JE. Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis. J Am Coll Cardiol. 2002; 39:1151–1158.CrossrefMedlineGoogle Scholar8. Dilsizian V, Bonow RO. Current diagnostic techniques of assessing myocardial viability in patients with hibernating and stunned myocardium. Circulation. 1993; 87:1–20.LinkGoogle Scholar9. Udelson JE, Coleman PS, Metherall J, Pandian NG, Gomez AR, Griffith JL, Shea NL, Oates E, Konstam MA. Predicting recovery of severe regional ventricular dysfunction: comparison of resting scintigraphy with 201Tl and 99mTc-sestamibi. Circulation. 1994; 89:2552–2561.LinkGoogle Scholar10. Afridi I, Kleiman NS, Raizner AE, Zoghbi WA. Dobutamine echocardiography in myocardial hibernation: optimal dose and accuracy in predicting recovery of ventricular function after coronary angioplasty. Circulation. 1995; 91:663–670.LinkGoogle Scholar11. Wagner A, Mahrholdt H, Holly TA, Elliott MD, Regenfus M, Parker M, Klocke FJ, Bonow RO, Kim RJ, Judd RM. Contrast-enhanced MRI and routine single photon emission computed tomography (SPECT) perfusion imaging for detection of subendocardial myocardial infarcts: an imaging study. Lancet. 2003; 361:374–379.CrossrefMedlineGoogle Scholar12. Mahnken AH, Koos R, Katoh M, Wildberger JE, Spuentrup E, Buecker A, Gunther RW, Kuhl HP. Assessment of myocardial viability in reperfused acute myocardial infarction using 16-slice computed tomography in comparison to magnetic resonance imaging. J Am Coll Cardiol. 2005; 45:2042–2047.CrossrefMedlineGoogle Scholar13. Lardo AC, Cordeiro MA, Silva C, Amado LC, George RT, Saliaris AP, Schuleri KH, Fernandes VR, Zviman M, Nazarian S, Halperin HR, Wu KC, Hare JM, Lima JA. Contrast-enhanced multidetector computed tomography viability imaging after myocardial infarction: characterization of myocyte death, microvascular obstruction, and chronic scar. Circulation. 2006; 113:394–404.LinkGoogle Scholar14. Bax JJ, Wijns W, Cornel JH, Visser FC, Boersma E, Fioretti PM. Accuracy of currently available techniques for prediction of functional recovery after revascularization in patients with left ventricular dysfunction due to chronic coronary artery disease: comparison of pooled data. J Am Coll Cardiol. 1997; 30:1451–1460.CrossrefMedlineGoogle Scholar15. Schinkel AF, Bax JJ, Poldermans D, Elhendy A, Ferrari R, Rahimtoola SH. Hibernating myocardium: diagnosis and patient outcomes. Curr Probl Cardiol. 2007; 32:375–410.CrossrefMedlineGoogle Scholar16. Kim RJ, Hillenbrand HB, Judd RM. Evaluation of myocardial viability by MRI. Herz. 2000; 25:417–430.CrossrefMedlineGoogle Scholar17. Baer FM, Voth E, Schneider CA, Theissen P, Schicha H, Sechtem U. Comparison of low-dose dobutamine-gradient-echo magnetic resonance imaging and positron emission tomography with [18F]fluorodeoxyglucose in patients with chronic coronary artery disease: a functional and morphological approach to the detection of residual myocardial viability. Circulation. 1995; 91:1006–1015.LinkGoogle Scholar18. Kuhl HP, Beek AM, van der Weerdt AP, Hofman MB, Visser CA, Lammertsma AA, Heussen N, Visser FC, van Rossum AC. Myocardial viability in chronic ischemic heart disease: comparison of contrast-enhanced magnetic resonance imaging with (18)F-fluorodeoxyglucose positron emission tomography. J Am Coll Cardiol. 2003; 41:1341–1348.MedlineGoogle Scholar19. Di Carli MF, Asgarzadie F, Schelbert HR, Brunken RC, Laks H, Phelps ME, Maddahi J. Quantitative relation between myocardial viability and improvement in heart failure symptoms after revascularization in patients with ischemic cardiomyopathy. Circulation. 1995; 92:3436–3444.LinkGoogle Scholar20. Louie HW, Laks H, Milgalter E, Drinkwater DC, Hamilton MA, Brunken RC, Stevenson LW. Ischemic cardiomyopathy: criteria for coronary revascularization and cardiac transplantation. Circulation. 1991; 84(suppl):III-290–III-295.Google Scholar21. Rahimtoola SH, Dilsizian V, Kramer CM, Marwick TH, Vanoverschelde JL. Chronic ischemic left ventricular dysfunction: from pathophysiology to imaging and its integration into clinical practice. J Am Coll Cardiol Cardiovasc Imaging. 2008; 1:536–555.CrossrefMedlineGoogle Scholar22. Yamaguchi A, Ino T, Adachi H, Mizuhara A, Murata S, Kamio H. Left ventricular end-systolic volume index in patients with ischemic cardiomyopathy predicts postoperative ventricular function. Ann Thorac Surg. 1995; 60:1059–1062.CrossrefMedlineGoogle Scholar23. Yamaguchi A, Ino T, Adachi H, Murata S, Kamio H, Okada M, Tsuboi J. Left ventricular volume predicts postoperative course in patients with ischemic cardiomyopathy. Ann Thorac Surg. 1998; 65:434–438.CrossrefMedlineGoogle Scholar24. Jones RH, Velasquez EJ, Michler RE, Sopko G, Oh JK, O'Connor CM, Hill JA, Menicanti L, Sadowski Z, Desvigne-Nickens P, Rouleau JL, Lee KLSTICH Hypothesis 2 Investigators. Coronary bypass surgery with or without surgical ventricular reconstruction. N Engl J Med. 2009; 360:1705–1717.CrossrefMedlineGoogle Scholar25. Elsasser A, Schlepper M, Klovekorn WP, Cai WJ, Zimmermann R, Muller KD, Strasser R, Kostin S, Gagel C, Munkel B, Schaper W, Schaper J. Hibernating myocardium: an incomplete adaptation to ischemia. Circulation. 1997; 96:2920–2931.LinkGoogle Scholar26. Beanlands RS, Hendry PJ, Masters RG, deKemp RA, Woodend K, Ruddy TD. Delay in revascularization is associated with increased mortality rate in patients with severe left ventricular dysfunction and viable myocardium on fluorine 18-fluorodeoxyglucose positron emission tomography imaging. Circulation. 1998; 98(suppl):II-51–II-56.Google Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Shah D, Kalekar D, Gupta D and Lamghare D Role of Late Gadolinium Enhancement in the Assessment of Myocardial Viability, Cureus, 10.7759/cureus.22844 (2022) Heart Failure Practical Cardiovascular Medicine, 10.1002/9781119832737.ch4, (103-155), Online publication date: 4-Mar-2022. Di Cesare E, Carerj S, Palmisano A, Carerj M, Catapano F, Vignale D, Di Cesare A, Milanese G, Sverzellati N, Francone M and Esposito A (2020) Multimodality imaging in chronic heart failure, La radiologia medica, 10.1007/s11547-020-01245-4, 126:2, (231-242), Online publication date: 1-Feb-2021. Yalampati R, Lalitha N and Murki N (2021) Factors Influencing Survival Outcomes in Patients with Left Ventricular Dysfunction after Coronary Revascularization, Indian Journal of Cardiovascular Disease in Women - WINCARS, 10.1055/s-0040-1709957, 06:01, (027-032), Online publication date: 1-Jan-2021. Bazylev V, Shmatkov M and P'ianzin A (2019) Remote results of myocardial endovascular revascularization in patients with low ejection fraction, Angiology and vascular surgery, 10.33529/ANGIO2019403, 25:4, (159), . Löffler A and Kramer C (2018) Myocardial Viability Testing to Guide Coronary Revascularization, Interventional Cardiology Clinics, 10.1016/j.iccl.2018.03.005, 7:3, (355-365), Online publication date: 1-Jul-2018. Nagueh S, Chang S, Nabi F, Shah D and Estep J (2017) Imaging to Diagnose and Manage Patients in Heart Failure With Reduced Ejection Fraction, Circulation: Cardiovascular Imaging, 10:4, Online publication date: 1-Apr-2017. (2017) Heart Failure Practical Cardiovascular Medicine, 10.1002/9781119233503.ch4, (93-141) Moreno P and del Portillo J (2017) Isquemia miocárdica: conceptos básicos, diagnóstico e implicaciones clínicas. Tercera parte, Revista Colombiana de Cardiología, 10.1016/j.rccar.2016.02.005, 24:1, (34-39), Online publication date: 1-Jan-2017. François C (2015) Current State of the Art Cardiovascular MR Imaging Techniques for Assessment of Ischemic Heart Disease, Radiologic Clinics of North America, 10.1016/j.rcl.2014.11.002, 53:2, (335-344), Online publication date: 1-Mar-2015. Singh P, Sethi N, Kaur N and Kozman H (2015) Revascularization in Severe Left Ventricular Dysfunction: Does Myocardial Viability Even Matter?, Clinical Medicine Insights: Cardiology, 10.4137/CMC.S18755, 9s1, (CMC.S18755), Online publication date: 1-Jan-2015. Lim S, Mc Ardle B, Beanlands R and Hessian R (2014) Myocardial Viability: It is Still Alive, Seminars in Nuclear Medicine, 10.1053/j.semnuclmed.2014.07.003, 44:5, (358-374), Online publication date: 1-Sep-2014. Husser O, Monmeneu J, Bonanad C, Lopez-Lereu M, Nuñez J, Bosch M, Garcia C, Sanchis J, Chorro F and Bodi V (2014) 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, Revista Española de Cardiología, 10.1016/j.recesp.2014.01.014, 67:9, (693-700), Online publication date: 1-Sep-2014. Husser O, Monmeneu J, Bonanad C, Lopez-Lereu M, Nuñez J, Bosch M, Garcia C, Sanchis J, Chorro F and Bodi V (2014) Prognostic Value of Myocardial Ischemia and Necrosis in Depressed Left Ventricular Function: a Multicenter Stress Cardiac Magnetic Resonance Registry, Revista Española de Cardiología (English Edition), 10.1016/j.rec.2014.01.013, 67:9, (693-700), Online publication date: 1-Sep-2014. Johnson F (2014) Pathophysiology and Etiology of Heart Failure, Cardiology Clinics, 10.1016/j.ccl.2013.09.015, 32:1, (9-19), Online publication date: 1-Feb-2014. Rajiah P, Desai M, Kwon D and Flamm S (2013) MR Imaging of Myocardial Infarction, RadioGraphics, 10.1148/rg.335125722, 33:5, (1383-1412), Online publication date: 1-Sep-2013. ten Kate G, Caliskan K, Dedic A, Meijboom W, Neefjes L, Manintveld O, Krenning B, Ouhlous M, Nieman K, Krestin G and de Feyter P (2014) Computed tomography coronary imaging as a gatekeeper for invasive coronary angiography in patients with newly diagnosed heart failure of unknown aetiology, European Journal of Heart Failure, 10.1093/eurjhf/hft090, 15:9, (1028-1034), Online publication date: 1-Sep-2013. Siefert A, Rabbah J, Koomalsingh K, Touchton S, Saikrishnan N, McGarvey J, Gorman R, Gorman J and Yoganathan A (2013) In Vitro Mitral Valve Simulator Mimics Systolic Valvular Function of Chronic Ischemic Mitral Regurgitation Ovine Model, The Annals of Thoracic Surgery, 10.1016/j.athoracsur.2012.11.039, 95:3, (825-830), Online publication date: 1-Mar-2013. Oh J, Velazquez E, Menicanti L, Pohost G, Bonow R, Lin G, Hellkamp A, Ferrazzi P, Wos S, Rao V, Berman D, Bochenek A, Cherniavsky A, Rogowski J, Rouleau J and Lee K (2012) Influence of baseline left ventricular function on the clinical outcome of surgical ventricular reconstruction in patients with ischaemic cardiomyopathy, European Heart Journal, 10.1093/eurheartj/ehs021, 34:1, (39-47), Online publication date: 1-Jan-2013. van Slochteren F, Teske A, van der Spoel T, Koudstaal S, Doevendans P, Sluijter J, Cramer M and Chamuleau S (2012) Advanced measurement techniques of regional myocardial function to assess the effects of cardiac regenerative therapy in different models of ischaemic cardiomyopathy, European Heart Journal - Cardiovascular Imaging, 10.1093/ehjci/jes119, 13:10, (808-818), Online publication date: 1-Oct-2012. Mielniczuk L and Beanlands R (2012) Imaging-Guided Selection of Patients With Ischemic Heart Failure for High-Risk Revascularization Improves Identification of Those With the Highest Clinical Benefit, Circulation: Cardiovascular Imaging, 5:2, (262-270), Online publication date: 1-Mar-2012. Braun J and Klautz R (2012) Mitral valve surgery in low ejection fraction, severe ischemic mitral regurgitation patients, Current Opinion in Cardiology, 10.1097/HCO.0b013e32834fec29, 27:2, (111-117), Online publication date: 1-Mar-2012. Cortigiani L, Bigi R and Sicari R (2011) Is viability still viable after the STICH trial?, European Heart Journal - Cardiovascular Imaging, 10.1093/ejechocard/jer237, 13:3, (219-226), Online publication date: 1-Mar-2012. Wells C, Rangasetty U and Subramaniam K (2012) Imaging in Heart Failure, International Anesthesiology Clinics, 10.1097/AIA.0b013e31825d8d80, 50:3, (55-82), . Vliegenthart R and Lubbers D (2012) Why are We Interested in Viability? CT Imaging of Myocardial Perfusion and Viability, 10.1007/174_2012_774, (155-171), . Shah B (2011) Geometry or function for the prediction of prognosis following revascularization in ischaemic cardiomyopathy: beyond the ejection fraction, European Journal of Echocardiography, 10.1093/ejechocard/jer131, 12:10, (807-807), Online publication date: 1-Oct-2011. Schuster A and Nagel E (2011) Letter by Schuster and Nagel Regarding Article, "Predicting Benefit From Revascularization in Patients With Ischemic Heart Failure: Imaging of Myocardial Ischemia and Viability", Circulation, 10.1161/CIRCULATIONAHA.111.025502, 124:11, Online publication date: 13-Sep-2011. February 1, 2011Vol 123, Issue 4 Advertisement Article InformationMetrics © 2011 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.109.903369PMID: 21282521 Originally publishedFebruary 1, 2011 Keywordsmagnetic resonance imagingmyocardial ischemiaviabilityrevascularizationcardiomyopathypositron emission tomographyPDF download Advertisement SubjectsChronic Ischemic Heart DiseaseComputerized Tomography (CT)Heart FailureImagingNuclear Cardiology and PET
Referência(s)