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
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Revista:
Anales de la Real Academia Nacional de Medicina

ISSN: 0034-0634

Ano de publicación: 2020

Número: 137

Páxinas: 65-72

Tipo: Artigo

DOI: 10.32440/AR.2020.137.01.ORG01 DIALNET GOOGLE SCHOLAR lock_openAcceso aberto editor

Outras publicacións en: Anales de la Real Academia Nacional de Medicina

Resumo

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.

Referencias bibliográficas

  • Torrent-Guasp F. Structure and function of the heart. Rev Esp Cardiol 1998;51:91-102.
  • Helm P, Beg MF, Miller MI, et al. Measuring and mapping cardiac fiber and laminar architecture using diffusion tensor MR imaging. Ann NY Acad Sci 2005;1047:296-307.
  • Bogaert J, Rademakers FE. Regional nonuniformity of normal adult human left ventricle. Am J Physiol Heart Circ Physiol 2001;280:H610-20.
  • Abraham WT, Fisher WG, Smith AL, et al; MIRACLE Study Group. Cardiac resynchronization in chronic heart failure. N Engl J Med 2002;346:1845-1853.
  • Rahimtoola SH. The hibernating myocardium. Am Heart J 1989;117:211-221.
  • Adelstein EC, Saba S. Scar burden by myocardial perfusion imaging predicts echocardiographic response to cardiac resynchronization therapy in ischemic cardiomyopathy. Am Heart J 2007;153:105-112.
  • Brandão SCS, Nishioka SAD, Giorgi MCP, et al. Cardiac resynchronization therapy evaluated by myocardial scintigraphy with 99mTc-MIBI: changes in left ventricular uptake, dyssynchrony and function. Eur J Nucl Med Mol Imaging 2009;36:986-996.
  • Trimble M, Borges-Neto S, Honeycutt E, et al. Evaluation of mechanical dyssynchrony and myocardial perfusion using phase analysis of gated SPECT imaging in patients with left ventricular dysfunction. J Nucl Cardiol 2008;15:663-670.
  • Al Jaroudi W, Chen J, Jaber WA, et al. Non-echocardiographic imaging in evaluation for cardiac resynchronization therapy. Circ Cardiovasc Imaging 2011;4:334-343.
  • Ypenburg C, Schalij M, Bleeker G, et al. Extent of viability to predict response to cardiac resynchronization therapy in ischemic heart failure patients. J Nucl Med 2006;47:1565-1570.
  • Chen J, Garcia EV, Folks RD, et al. Onset of left ventricular mechanical contraction as determined by phase analysis of ECG-gated myocardial perfusion SPECT imaging: development of a diagnostic tool for assessment of cardiac mechanical dyssynchrony. J Nucl Cardiol 2005;12:687-695.
  • Zhang F, Yang W, Wang Y, et al. Is there an association between hibernating myocardium and left ventricular mechanical dyssynchrony in patients with myocardial infarction? Hell J Nucl Med 2018;21:28-34.
  • Binder A, Ali A, Chawla R, et al. Myocardial protection from ischemia-reperfusion injury post coronary revascularization. Expert Rev Cardiovasc Ther 2015;13:1045-1057.
  • Alfonso F, García P, Pimentel G, et al.; Intravascular ultrasound study. Predictors and implications of residual plaque burden after coronary stenting: an intravascular ultrasound study. Am Heart J 2003;145:254-261.
  • Maruskova M, Gregor P, Bartunek J, et al. Myocardial viability and cardiac dyssynchrony as strong predictors of perioperative mortality in high-risk patients with ischemic cardiomyopathy having coronary artery bypass surgery. J Thorac Cardiovasc Surg 2009;138:62-68.
  • Bleeker GB, Kaandorp TA, Lamb HJ, et al. Effect of posterolateral scar tissue on clinical and echocardiographic improvement after cardiac resynchronization therapy. Circulation 2006;113:969-976.
  • Sciagra R, Giaccardi M, Porciani MC, et al. Myocardial perfusion imaging using gated SPECT in heart failure patients undergoing cardiac resynchronization therapy. J Nucl Med 2003;45:164-168.
  • Bilchick KC, Dimaano V, Wu KC, et al. Cardiac magnetic resonance assessment of dyssynchrony and myocardial scar predicts function class improvement following cardiac resynchronization therapy. J Am Coll Cardiol 2008;1:561-568.
  • Leyva F, Foley PWX, Stegemann B, et al. Development and validation of a clinical index to predict survival after cardiac resynchronisation therapy. Heart 2009;95:1619-1625.
  • Bax JJ, van der Wall EE, Harbinson M. Radionuclide techniques for the assessment of myocardial viability and hibernation. Heart 2004; 90(Suppl. V):V26-V33.
  • Tajoury TH, Chareonthaitawee P. Myocardial viability imaging and revascularization in chronic ischemic left ventricular dysfunction. Expert Rev Cardiovasc Ther 2010;8:55-63.
  • Allman KC, Shaw LJ, Hachamovitch R, et al. Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular systolic dysfunction: a meta-analysis. J Am Coll Cardiol 2002;39:1151-1158.
  • Bax JJ, Poldermans D, Elhendy A, et al. Sensitivity, specificity, and predictive accuracies of various noninvasive techniques for detecting hibernating myocardium. Curr Probl Cardiol 2001;26:141-186.
  • Velázquez EJ, Lee K, Deja MA, et al.; STICH Investigators. Coronary‐artery bypass surgery in patients with left ventricular dysfunction. N Engl J Med 2011;364:1607‐1616.
  • Bonow RO, Maurer G, Lee KL, et al. Myocardial viability and survival in ischemic left ventricular dysfunction. N Engl J Med 2011;364:1617‐1625.
  • Schwarz ER, Schoendube FA, Kostin S, et al. Prolonged myocardial hibernation exacerbates cardiomyocyte degeneration and impairs recovery of function after revascularization. J Am Coll Cardiol 1998;31:1018-1026.
  • Beanlands RS, Nichol G, Huszti E, et al.; PARR-2 Investigators. F18-Fluorodeoxyglucose positron emission tomography imaging-assisted management of patients with severe left ventricular dysfunction and suspected coronary disease: a randomized, controlled trial (PARR-2). J Am Coll Cardiol 2007;50:2002-2012.
Fonte de datos: Dialnet