Evaluation of myocardial viability in patients with coronary heart disease complicated with advanced left ventricular dysfunction

Cover Page

Cite item

Full Text

Abstract

Review of the literature on myocardial viability evaluation at the stage of surgical treatment planning in patients with coronary heart disease complicated with advanced left ventricular dysfunction is presented. In significant number of patients myocardial revascularization may improve regional and global heart function, and lead to further clinical improvement. The underlying pathophysiology involves different types of reversible myocardial dysfunction (hibernation, stunning), which may co-exist within the same patient’s myocardium. Potentially reversible left ventricular dysfunction is characterized by preserved cell membrane integrity and cardiomyocyte metabolism (sufficient to maintain cellular functions and cell membrane integrity in conditions of chronic or repetitive ischemia). Another important objective when assessing myocardial viability - pre-operative evaluation of post-infarction aneurysms in patients with severe left ventricular dysfunction. Results of clinical trials assessing the effectiveness of surgical revascularization in patients with ischemic cardiomyopathy as well as the results of the clinical trial on surgical treatment of ischemic heart failure are presented. A spectrum of non-invasive methods of myocardial viability evaluation, including the most studied nuclear, allows to identify cases of reversible left ventricular dysfunction in patients with congestive heart failure and to make a prognosis on success of the surgical treatment.

About the authors

G B Saifullina

Interregional Clinical Diagnostic Center, Kazan, Russia

Email: sayfullina_rad@mail.ru

M M Ibatullin

Interregional Clinical Diagnostic Center, Kazan, Russia

A R Sadykov

Interregional Clinical Diagnostic Center, Kazan, Russia

N M Valiullina

Interregional Clinical Diagnostic Center, Kazan, Russia

References

  1. Мареев В.Ю., Агеев Ф.Т., Арутюнов Г.П., Ревишвили А.Ш. Национальные рекомендации ВНОК и ОССН по диагностике и лечению ХСН (третий пересмотр) // Ж. сердечн. недост. - 2010. - №1. - С. 3-62.
  2. Остроумов Е.Н., Котина Е.Д., Честухин В.В. и др. Комментарий к результатам исследования STICH // Ж. сердечн. недост. - 2011. - №4. - С. 232-237.
  3. Саидова М.А., Беленков Ю.Н., Акчурин Р.С. и др. Жизнеспособный миокард: сравнительная оценка хирургического и медикаментозного методов лечения больных ишемической болезнью сердца с постинфарктным кардиосклерозом и хронической сердечной недостаточностью // Тер. архив. - 2002. - №2. - С. 60-64.
  4. Шумаков В.И., Остроумов Е.Н. Радионуклидные методы диагностики в клинике ишемической болезни и трансплантации сердца. - М.: Дрофа, 2003. - 224 с.
  5. Allman K.C., Shaw L.J., Hachamovitch R. et al. Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery ventricular dysfunction: a meta-analysis // J. Am. Coll. Cardiol. - 2002. - Vol. 39. - P. 1151-1158.
  6. Al-Mohammad A., Mahy I.R., Norton M.Y. et al. Prevalence of hibernating myocardium in patients with severely impaired ischaemic left ventricles // Heart. - 1998. - Vol. 80. - P. 559-564.
  7. Auerbach M.A., Schoeder H., Hoh C. et al. Prevalence of myocardial viability as detected by positron emission tomography in patients with ischemic cardiomyopathy // Circulation. - 1999. - Vol. 99. - P. 2921-2926.
  8. Bax J.J., Visser F.C., Poldermans D. et al. Relationship between preoperative viability and postoperative improvement in LVEF and heart failure symptoms // J. Nucl. Med. - 2001. - Vol. 42. - P. 79-86.
  9. Buckberg G.D. Questions and answers about the STICH trial: a different perspective // J. Thorac. Cardiovasc. Surg. - 2005. - Vol. 130. - P. 245-249.
  10. Buckberg G.D., Athanasuleas C.L. Decision making in ischemic cardiomyopathy: is the Cleveland Clinic model valid? // J. Thorac. Cardiovasc. Surg. - 2010. - Vol. 140. - P. 1203-1205.
  11. Buckberg G.D., Athanasuleas C.L., Wechsler A.S. et al. The STICH trial unraveled // Eur. J. Heart Fail. - 2010. - Vol. 12. - P. 1024-1027.
  12. Canty J.M., Suzuki G., Banas M.D. et al. Hibernating myocardium: chronically adapted to ischemia but vulnerable to sudden death // Circ. Res. - 2004. - Vol. 94. - P. 1142-1149.
  13. Chen C., Chen L., Fallon J.T. et al. Functional and structural alterations with 24-hour myocardial hibernation // Circulation. - 1996. - Vol. 94. - P. 507-516.
  14. Christian T.F., Miller T.D., Hodge D.O. et al. An estimate of the prevalence of reversible left ventricular dysfunction in patients referred for coronary artery bypass surgery // J. Nucl. Cardiol. - 1996. - Vol. 4 - P. 140-146.
  15. Di Donato M., Sabatier M., Dor V. Akinetic versus dyskinetic postinfarction scar: relation to surgical outcome in patients undergoing endoventricular circular patch plasty repair // JACC. - 1997. - N 29. - Р. 1569-1575.
  16. Dispersyn G.D., Borgers M., Flameng W. Apoptosis in chronic hibernating myocardium: sleeping to death? // Cardiovasc. Res. - 2000. - N 45. - P. 696-703.
  17. Eagle K.A., Guyton R.A., Davidoff R. et al. ACC/AHA 2004 Guideline update for coronary artery bypass graft surgery // http://www.acc.org. (Дата обращения: 20.11.2009 г.)
  18. Eberli F.R. Stunned myocardium - an unfinished puzzle // Cardiovasc. Res. - 2004. - N 63. - P. 189-191.
  19. Faxon D.P., Ryan T.J., Davis K.B. et al. Prognostic significance of angiographically documented left ventricular aneurysm from the Coronary Artery Surgery Study (CASS) // Am. J. Cardiol. - 1982. - Vol. 50. - P. 157-164.
  20. Haas F., Hachnel C.J., Picker W. et al. Preoperative positron emission tomographic viability assessment and perioperative and postoperative risk in patients with advanced ishemic heart disease // JACC. - 1997. - Vol. 96. - P. 793-800.
  21. Iskandrian A.E., van der Wall E. Myocardial viability. - Kluwer Academic Publishers, 2002. - 206 p.
  22. Jones R.H., Velazquez E.J., Michler R.E. et al. Coronary bypass surgery with or without surgical reconstruction // N. Engl. J. Med. - 2009. - Vol. 360. - P. 1705-1717.
  23. Kim S.J., Depre C., Vartner S.F. Novel mechanisms mediating stunned myocardium // Heart Fail. Rev. - 2003. - Vol. 8 - P. 143-153.
  24. Kirklin J.W., Barratt-Boyes B.G. Cardiac Surgery. - New York, 1996. - P. 383-402.
  25. Klocke F.J., Baird M.G., Lorell B.H. et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging: a report of the American College of Cardiology/American Heart Association Task Force on practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging) (2003) // http://www.acc.org. (Дата обращения: 16.05.2008 г.)
  26. Kloner R.A., Jennings R.B. Cosequences of brief ischemia: stunning, preconditioning, and thier clinical implications: Part 1 // Circulation. - 2001. - Vol. 104. - P. 2981-2989.
  27. Kloner R.A., Jennings R.B., Rasmussen M.M. Cosequences of brief ischemia: stunning, preconditioning, and thier clinical implications: Part 2 // Circulation. - 2001. - Vol. 104. - P. 3158-3167.
  28. Rahimtoola S.H. Coronary bypass surgery for chronic angina-1981 // Circulation. - 1982. - Vol. 65. - P. 225-241.
  29. Rahimtoola S.H. A perspective on three large multicenter randomized clinical trials of coronary bypass surgery for chronic stable angina // Circulation. - 1985. - Vol. 72. - P. 123-135.
  30. Rahimtoola S.H. The hibernating myocardium // Am. Heart J. - 1989. - Vol. 117. - P. 211-221.
  31. Ross J.Jr. Myocardial perfusion-contraction matching. Implications for coronary heart disease and hibernation // Circulation. - 1991. - Vol. 83. - P. 1076-1083.
  32. Schinkel A.F.L., Baxx J.J., Sozzi F.B. et al. Prevalence of myocardial viability assessed by single photon emission computed tomography in patients with chronic ischaemic left ventricular dysfunction // Heart. - 2002. - Vol. 88. - P. 125-130.
  33. Sutton M., Sharpe N. Left ventricular remodeling after myocardial infarction. Pathophysiology and therapy // Circulation. - 2000. - №101. - Р. 2981-2987.
  34. Velazquez E.J., Kerry L.L., Marek A.D. et al. Coronary-artery bypass surgery in patients with left ventricular dysfunction // N. Engl. J. Med. - 2011. - Vol. 364. - P. 1607-1616.
  35. Zaret B.L., Beller G.A. Clinical nuclear cardiology: state of the art and future directions. 3rd edition. - Elsevier MOSBY, 2005. - P. 559-575.

© 2012 Saifullina G.B., Ibatullin M.M., Sadykov A.R., Valiullina N.M.

Creative Commons License

This work is licensed
under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.




This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies