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Myocardial Viability: Comparison with Other Imaging Techniques

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Contrast Echocardiography in Clinical Practice

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Abstract

Myocardial viability may be defined as myocardium with preserved metabolic, cel lular and membrane function which allows the myocardium to maintain its contractile function. Thus, the mere presence of contractile function suggests that the myocardium is viable. However, the clinical scenario where assessment of myocardial viability is an issue is when there is regional or global left ventricular dysfunction in the context of coronary artery disease. There are two broad scenarios of coronary artery disease where this can occur. The first scenario is when the reduction of contractile function with preserved metabolic, cellular and membrane function may occur when myocardial blood flow is chronically reduced (‘hibernating myocardium’) or when the myocardial blood flow is normal at rest but there is repetitive demand-induced ischaemia in presence of non-flow-limiting coronary artery stenosis at rest (‘stunned, myocardium’) [2].

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References

  1. Rahimtoola SH.A perspective on the three large multicenter randomised clinical trials of coronary bypass surgery for chronic stable angina. Circulation 1985; 72: V123–35

    Article  PubMed  CAS  Google Scholar 

  2. Vanoverschelde JL, Wijns W, Depre C et al. Mecha nisms of chronic regional post-ischaemic dysfunction in humans: new insights from the study of nonin-farcted collateral-dependent myocardium. Circulation 1993; 87: 1513–32

    Article  PubMed  CAS  Google Scholar 

  3. Baronial E, Loner RA. The stunned myocardium: prolonged, postischemic ventricular dysfunction. Circulation 1982; 66: 1146–9

    Article  Google Scholar 

  4. Kaul S, Force T. Assessment of myocardial perfusion with contrast two dimensional echocardiography. In Weyman AE (ed): Principles and Practice of Echocardiography. 2nd ed. Philadelphia: Lea and Febiger 1993: 687–730

    Google Scholar 

  5. Kaul S. Clinical applications of myocardial contrast echocardiography. Am J Cardiol 1992; 69-46H–55H

    Article  PubMed  CAS  Google Scholar 

  6. Kaul S, Jayaweera AR. Myocardial contrast echocardiography has the potential for the assessment of coronary microvascular reserve. J Am Coll Cardiol 1993; 21: 356–358

    Article  PubMed  CAS  Google Scholar 

  7. Kassab GS, Lin DH, Fung YB. Morphometry of pig coronary venous system. Am J Physiol 1994; 267 (6 Pt2): H2100–13

    PubMed  CAS  Google Scholar 

  8. Kaul S, Jayaweera AR. Coronary and myocardial blood volumes: noninvasive tools to assess the coronary microcirculation? Circulation 1997; 96: 719–724

    PubMed  CAS  Google Scholar 

  9. Linka AZ, Sklenar J, Wei K, Jayaweera AR, Skyba DM, Kaul S. Spatial distribution of microbubble velocity and concentration within the myocardium: insight into transmural distribution of myocardial blood flow and volume. Circulation 1998; 98: 1912–1920

    Article  PubMed  CAS  Google Scholar 

  10. Wei K, Jayaweera AR, Firoozan S, Linka A, Skyba DM, Kaul S. Quantification of myocardial blood flow with ultrasound-induced destruction of microbubbles administered as a continuous infusion. Circulation 1998; 97: 473–483

    Article  PubMed  CAS  Google Scholar 

  11. Wei K, Linka A, Jayaweera AR, Firoozan S Goodman NC, Kaul S. Basis of stenosis detection by myocardial contrast echocardiography during venous administration of microbubbles: bolus or continuous infusion? J Am Coll Cardiol 1998; 32: 252–260

    Article  PubMed  CAS  Google Scholar 

  12. Tiemann K, Lohmeier S, Kuntz S, Köster J, Pohl C, Burns PN, Porter TR, Nanda NC, Lüderitz B, Becher HL. Real-time contrast echo assessment of myocardial perfusion at low emission power: first experimental and clinical results using power pulse inversion imaging. Echocardiography 1999; 16: 799–809

    Article  PubMed  Google Scholar 

  13. Kloner RA, Rude RE, Carlson N, et al. Ultrastructural evidence of microvascular damage and myocardial cell injury after coronary artery occlusion: which comes first? Circulation 1980; 62: 945–952

    Article  PubMed  CAS  Google Scholar 

  14. Ragosta M, Camarano G, Kaul S, Powers ER, Sarem-bock IJ, Gimple LW. Microvascular integrity indicates myocellular viability in patients with recent myocardial infarction. New insights using myocardial contrast echocardiography. Circulation 1994; 89: 2562–9

    Article  PubMed  CAS  Google Scholar 

  15. Janardhanan R, Swinburn J, Greaves K, Senior R. Usefulness of Myocardial Contrast Echocardiography using low power continous imaging early after acute myocardial infarction to predict late functional left ventricular recovery. Am J Cardiol 2003

    Google Scholar 

  16. Ito H, Tomooka T, Sakai N. Yu H, Higashina Y, Fujii K, Masuyama T, Kitabatake A, Minamino T. Lack of myocardial perfusion immediately after successful thrombolysis. A predictor of poor recovery of left ventricular function in anterior myocardial infarction. Circulation 1992; 85: 1699–1705

    Article  PubMed  CAS  Google Scholar 

  17. Reimer KA, Jennings RB. The “wavefront phenomenon” of myocardial ischemic cell death. II. Transmural progression of necrosis within the framework of ischemic bed size (myocadium at risk) and collateral flow. Lab Invest 1979; 40: 633–44

    PubMed  CAS  Google Scholar 

  18. Jugdutt BI, Hutchins GM, Bulkley BM, Becker LC. Myocardial infarction in the conscious dog: three-dimensional map** of infarct, collateral flow and region at risk. Circulation 1979; 60: 1141–50

    Article  PubMed  CAS  Google Scholar 

  19. Johnson WB, Malone SA, Bantely GA, Anselone CG, Bristow JD. No reflow and extent of infarction during maximal vasodilatation in the porcine heart. Circulation 1988; 78: 462–472

    Article  PubMed  CAS  Google Scholar 

  20. Vanhecke J, Flaeng W, Borgers M, Jan I, Van de Werf F, De Geest H. Evidence for decreased coronary flow reserve in viable postischemic myocardium. Circ Res 1990; 67: 1201–1210

    Article  Google Scholar 

  21. The TIMI Study Group. Comparison of invasive and conservative strategies after treatment with intravenous tissue plasminogen activator in acute myocardial infarction: results of the Thrombolysis in Myocardial Infarction (TIMI) phase II trial. N Engl J Med 1989; 320: 618–627

    Article  Google Scholar 

  22. Swinburn JMA, Lahiri A, Senior R. Intravenous myocardial contrast echocardiography predicts recovery of dysynergic myocardium early after acute myocardial infarction. J Am Coll Cardiol 2001; 38: 19–25

    Article  PubMed  CAS  Google Scholar 

  23. Coggins MP, Sklenar J, Le DE, et al. Noninvasive Prediction of Ultimate Infarct Size at the Time of Acute Coronary Occlusion Based on the Extent and Magnitude of Collateral-Derived Myocardial Blood Flow. Circulation 2001; 104: 2471–2477

    Article  PubMed  CAS  Google Scholar 

  24. Lafitte S, Higashiyama A, Masugata H, Peters B, Strachan M, Kwan OL, DeMaria AN. Contrast echocardiography can assess risk area and infarct size during coronary occlusion and reperfusion: experimental validation. J Am Coll Cardiol 2002; 39: 1546–54

    Article  PubMed  Google Scholar 

  25. Janardhanan R, Moon JCC, Pennell DJ, Senior R. Pre diction of the extent of myocardial necrosis and contractile reserve after reperfusion therapy following acute myocardial infarction: comparison between myocardial contrast echocardiography and contrast enhanced cardiovascular magnetic resonance. J Am Coll Cardiol ,2003; 41(6): 4394

    Google Scholar 

  26. Kaul S, Villaneuva FS. Is the determination of myocardial perfusion necessary to evaluate the success of reperfusion when the infarct related artery is open? Circulation 1992; 85: 1942–1944

    Article  PubMed  CAS  Google Scholar 

  27. Villanueva FS, Glasheen WP, Sklenar J, Kaul S. Characterization of spatial patterns of flow within the reperfused myocardium using myocardial contrast echocardiography: implications in determining the extent of myocardial salvage Circulation 1993; 88: 2596–2606

    Article  PubMed  CAS  Google Scholar 

  28. Agati L, Voci P, Vilotta F et al. Influence of residual perfusion within the infarct zone on the natural history of left ventricular dysfunction after acute myocardial infarction: a myocardial contrast echocardiographic study. J Am Coll Cardiol 1994; 24: 336–42

    Article  PubMed  CAS  Google Scholar 

  29. Ito H, Iwakura K, Masuyama T, Hori M, Higashino Y, Fujii K, Minamino T. Temporal changes in myocardial perfusion patterns in patients with reperfused anterior wall myocardial infarction. Their relation to myocardial viability. Circulation 1995; 91: 656–62

    Article  PubMed  CAS  Google Scholar 

  30. Brochet E, Czitrom B, Darila-Cohen D, et al. Early changes in myocardial perfusion patterns after myocardial infarction: relation with contractile reserve and functional recovery. J Am Coll Cardiol 1998; 32: 2011–7

    Article  PubMed  CAS  Google Scholar 

  31. Czitrom D, Karila-Cohen D, Brochet E, et al. Acute assessment of microvascular perfusion patterns by myocardial contrast echocardiography during myocardial infarction: relation to timing and extent of functional recovery. Heart 1999; 81: 12–16

    PubMed  CAS  Google Scholar 

  32. Myers JH, Stirling MC, Choy M, et al. Direct measurement of inner and outer wall thickening dynamics with epicardial echocardiography. Circulation 1986; 74: 164–72

    Article  PubMed  CAS  Google Scholar 

  33. Swinburn J, Senior R. Real-time contrast echocardiography -a new bedside technique to predict contractile reserve early after acute myocardial infarction. Eur J Echocardiogr 2002; 3: 95–99

    Article  PubMed  CAS  Google Scholar 

  34. Main ML, Magalski A, Chee NK, Coen MM, Skolnick DG, Good TH. Full-motion pulse inversion power Doppler contrast echocardiography differentiates stunning from necrosis and predicts recovery of left ventricular function after acute myocardial infarction. J Am Coll Cardiol 2001; 38: 1390–4

    Article  PubMed  CAS  Google Scholar 

  35. deFilippi CR, Willett DL, Irani WN et al. Comparison of myocardial contrast echocardiography and low-dose dobutamine stress echocardiography in predicting recovery of left ventricular function after coronary revascularization in chronic ischemic heart disease. Circulation 1995; 92: 2863–2868

    Article  PubMed  CAS  Google Scholar 

  36. Nagueh SF, Vaduganathan P, Ali N, et al. Identification of hibernating myocardium: comparative accuracy of myocardial contrast echocardiography, rest-redistribution thallium-201 tomography and dobutamine echocardiography. J Am Coll Cardiol 1997; 29: 985–993

    Article  PubMed  CAS  Google Scholar 

  37. Camarano G, Ragosta M, Gimple LW et al. Identification of viable myocardium with contrast echocardiography in patients with poor left ventricular systolic function caused by recent or remote myocardial infarction. Am J Cardiol 1995; 75: 219–219

    Article  Google Scholar 

  38. Shimoni S, Frangogiannis NG, Aggeli CJ, et al. Microvascular structural correlates of myocardial contrast echocardiography in patients with coronary artery disease and left ventricular dysfunction: implications for the assessment of myocardial hibernation. Circulation 2002;106:950–6

    Article  PubMed  Google Scholar 

  39. Di Carli MF, Davidson M, Little R et al. Value of metabolic imaging with positron emission tomography for evaluating prognosis in patients with coronary artery disease and left ventricular dysfunction. Am J Cardiol 1994; 73: 527–33

    Article  PubMed  Google Scholar 

  40. Bonow RP, Dilsizian V, Cuocol A, Bacharach SL. Identification of viable myocardium in patients with chronic coronary artery disease and left ventricular dysfunction. Comparison of thallium scintigraphy with reinjection and PET imaging with 18F-fluo-rodeoxyglucose. Circulation 1991; 83: 26–37

    Article  PubMed  CAS  Google Scholar 

  41. Kitsiou AN, Srinivasan G, Quyyumi AA, Summers RM, Bacharach SL, Dilsizian V. Stress-induced reversible and mild-to-moderate irreversible thallium defects. Are they equally accurate for predicting recovery of regional left ventricular function after revascularization? Circulation 1998; 98: 501–508

    Article  PubMed  CAS  Google Scholar 

  42. Udelson J, Coleman P, Metherall J et al. Predicting recovery of severe regional ventricular dysfunction comparison of resting scintigraphy with 201T1 and 99mTc-sestamibi. Circulation 1994; 89: 2552–2661

    Article  PubMed  CAS  Google Scholar 

  43. Bisi G, Sciagra R, Santoro GM, Rossi V, Fazzini PF. Technetium-99m sestamibi imaging with nitrate infusion to detect viable hibernating myocardium and predict post revascularisation recovery. J Nucl Med 1995; 46: 1994–2000

    Google Scholar 

  44. Senior R. Kaul S and Lahiri A. Myocardial viability on echocardiography predicts long term survival after revascularisation in patients with ischaemic congestive heart failure. J Am Coll Cardiol 1999; 33: 1848–1854

    Article  PubMed  CAS  Google Scholar 

  45. Senior R, Lahiri A. Dobutamine echocardiography predicts functional outcome after revascularisation in patients with dysfunctional myocardium irre spective of the perfusion pattern on resting thallium-201 imaging. Heart 1999; 82: 668–673

    PubMed  CAS  Google Scholar 

  46. Afridi I, Grayvurn PA, Panza JA et al. Myocardial viability during dobutamine echocardiography predicts survival in patients with coronary artery disease and severe left ventricular dysfunction. J Am Coll Cardiol 1998; 32: 921–926

    Article  PubMed  CAS  Google Scholar 

  47. Dendale PA, Franken PR, Waldman GF et al. Low-dosage dobutamine magnetic resonance imaging as an alternative to echocardiography in the detection of viable myocardium after acute myocardial infarction. Am Heart J 1995; 130: 134–140

    Article  PubMed  CAS  Google Scholar 

  48. Baer FM, Voth E, LaRosee et al. Comparison of dobutamine transesophageal echocardiography and dobutamine magnetic resonance imaging for detection of residual myocardial viability. Am J Cardiol 1996; 78: 415–419

    Article  PubMed  CAS  Google Scholar 

  49. Kim RJ, Fieno DS, Parrish TB et al. Relationship of MRI delayed contrast enhancement to irreversible injury, infarct, age, and contractile function. Circulation 1999; 100: 1992–2002

    Article  PubMed  CAS  Google Scholar 

  50. Kim RJ, Wu E, Rafael A. The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med 2000; 43: 1445–53

    Article  Google Scholar 

  51. Sklenar J, Camarano G, Ismail S, Goodman N, Kaul S. The effect of coronary stenosis on contractile reserve after acute myocardial infarction: implications in using dobutamine echocardiography for assessing extent of myocardial salvage after reperfusion. [Abstract]. Circulation 1994; 90 (suppl): 1–1172

    Article  Google Scholar 

  52. Kaul S. Dobutamine echocardiography for determining myocardial viability after reperfusion: experimental and clinical observations. Eur Heart J 1995; 16: 17–23

    Article  PubMed  Google Scholar 

  53. Agati L, Voci P, Luongo R et al. Combined use of dobutamine echocardiography and myocardial contrast echocardiography to predict recovery of regional dysfunction after coronary revascularization in patients with recent myocardial infarction. Eur Heart J 1997; 18: 771–9

    Article  PubMed  CAS  Google Scholar 

  54. Iliceto S, Galiuto L, Marchese A et al. Analysis of microvascular integrity contractile reserve, and myocardial viability after acute myocardial infarction by dobutamine echocardiography and myocardial contrast echocardiography. Am J Cardiol 1996; 77:441–5

    Article  PubMed  CAS  Google Scholar 

  55. Senior R, Swinburn JM. Incremental value of myocardial contrast echocardiography for the prediction of recovery of function in dobutamine non-responsive myocardium early after acute myocardial infarction. Am J Cardiol 2003; 91(4): 397–402

    Article  PubMed  Google Scholar 

  56. Meza MF, Kates MA, Barbee RW, Revall S, Perry B, Murgo JP, Cheirif J. Combination of dobutamine and myocardial contrast echocardiography to differentiate postischaemic from infracted myocardium. J Am Coll Cardiol 1997; 29: 974–84

    Article  PubMed  CAS  Google Scholar 

  57. Senior R, Kaul S, Soman P, Lahiri A. Power Doppler harmonic imaging: a feasibility study of a new technique for the assessment of myocardial perfusion. Am Heart J 2000; 139: 245–51

    PubMed  CAS  Google Scholar 

  58. Krishnamani R and Senior R. Evaluation of myocardial viability after myocardial infarction. European Heart J 2002; 4 Supp C: C35–C38

    Google Scholar 

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Senior, R. (2004). Myocardial Viability: Comparison with Other Imaging Techniques. In: Contrast Echocardiography in Clinical Practice. Springer, Milano. https://doi.org/10.1007/978-88-470-2125-9_9

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  • DOI: https://doi.org/10.1007/978-88-470-2125-9_9

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2174-7

  • Online ISBN: 978-88-470-2125-9

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