Potencial contribución del miocardio hibernado al comportamiento mecánico ventricular en la enfermedad coronaria residual post-intervencionismo. Experiencia piloto aplicando análisis de fase por tomografía de emisión de fotón único gatillada (gated-SPECT)

  1. Federico Ferrando-Castagnetto 1
  2. María Pedrera Canal 2
  3. Carlos Real 3
  4. María Fernanda Ollarves Carrero 2
  5. José Carlos Rodríguez Gómez 2
  6. Cristina Gamila Wakfie-Corieh 2
  7. María Jesús Pérez Castejón 2
  8. José Luis Carreras Delgado 2
  1. 1 Departamento de Cardiología, Centro Cardiovascular Universitario. Hospital de Clínicas Dr. Manuel Quintela, Facultad de Medicina; Universidad de la República. Montevideo; Servicio de Medicina Nuclear, Hospital Clínico San Carlos
  2. 2 Servicio de Medicina Nuclear, Hospital Clínico San Carlos
  3. 3 Instituto Cardiovascular, Hospital Clínico San Carlos
Anales de la Real Academia Nacional de Medicina

ISSN: 0034-0634

Year of publication: 2020

Issue: 137

Pages: 65-72

Type: Article

DOI: 10.32440/AR.2020.137.01.ORG01 DIALNET GOOGLE SCHOLAR lock_openOpen access editor

More publications in: Anales de la Real Academia Nacional de Medicina


Hibernation is a reversible myocyte pathophysiological substrate that can be detected by several imaging techniques. However, the true impact of the amount of viable myocardium on left ventricular contractile dynamics has been poorly evaluated. OBJECTIVE: To analyze the correlation of viable myocardium with left ventricle mechanical dyssynchrony in subjects with residual stenosis after percutaneous coronary intervention. METHODS: Phase standard deviation (PSD) and phase bandwidth (PBW) at rest were obtained in a retrospective sample of patients referred to gated-SPECT. Patients in non-sinus rhythm, wide QRS, renal dysfunc tion, hypertrophic cardiomyopathy and valvular heart disease were excluded. The sample was divided into two groups according to the presence (n=25) or absence (n=90) of residual epicardial disease after an acute coronary event. Phase analysis (PA) indexes were correlated with the amount of viable myocardium applying two uptake thresholds (40% and 50%) using Pearson coefficient (r). RESULTS. Both groups of patients did not differed in age, basal LVEF or cavitary volumes. The amount of nonviable myocardium was better correlated with PA indexes in the presence of residual epicardial lesions. This correlation was more powerful for PBW (r=0.82, 95% CI: 0.63-0.91, p<0.0001) than for PSD (r=0.77, 95% CI: 0.53-0.89, p<0.0001) and decreased to r=0.73 and 0.77, respectively, when a higher viability threshold was considered (50%). The best correlation was observed in those with residual lesions and fixed perfusion defects suggestive of scar (r=0.93 for ABF, p <0.0001). CONCLUSIONS: In patients with residual stenosis after percutaneous coronary intervention, the amount of hibernated myocardium correlates closely with mechanical ventricular dyssynchrony. The best correlation is observed when using a baseline myocardial uptake threshold of at least 40%, especially when scar tissue coexists.

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