(Circulation. 1996;94:308-315.)
© 1996 American Heart Association, Inc.
Articles |
Only Hibernating Myocardium Invariably Shows Early Recovery After Coronary Revascularization
the Departments of Cardiac Surgery (B.S., W.F.), Nuclear Medicine (A.M., J.N., L.M.), and Epidemiology (I.S.), Katholieke Universiteit Leuven, Belgium; and the Department of Morphology, Janssen Research Foundation, Belgium, and Department of Molecular Cell Biology, Cardiovascular Research Institute, University of Limburg, Netherlands (M.B., J.A.).
Background The aims of this study were to identify hibernating myocardium (hypocontractile, hypoperfused viable myocardium that regains contractility after revascularization) in the clinical setting and to predict functional outcome in patients with coronary artery disease after coronary revascularization.
Methods and Results Preoperative data related to the anterior free wall of the left ventricle were collected in 50 coronary bypass surgery candidates (positron emission tomography [PET], [13N]NH3 for flow, and [18F]FDG for metabolism [MET]; equilibrium-gated nuclear angiography [EGNA] for regional ejection fraction [REF]; and histological data from myocardial biopsies for percentage fibrosis and viable myocytes). Three months after surgery, the patients had follow-up PET and EGNA investigations. A principal-components analysis identified four patient clusters. Cluster 1 (n=9) had normal viable myocardium. Cluster 2 (n=18) had viable hypocontractile myocardium (REF, 39±12%) showing a PET mismatch pattern. Cluster 3 (n=16) had viable hypocontractile myocardium associated with morphological myocyte injury showing a matched moderate decrease in flow (66±11%) and MET (70±11%). Cluster 4 (n=7) had hypocontractile myocardium with mainly scar tissue (fibro-sis, 74±12%). After surgery, only cluster 2, with hibernating myocardium, showed significant improvement in REF (from 39±12% to 50±13%, P<.05). Cluster 3, with sites of morphological myocyte injury, showed no recovery. The stepwise logistic regression showed a combination of low preoperative REF and high MET to be the best predictor of functional recovery (P<.008).
Conclusions Multivariate analysis identifies hibernating myocardium showing early postrevascularization recovery, as opposed to viable but myolytic myocardium with no early recovery. Postrevascularization recovery can be predicted (combination of low REF and high MET) by noninvasive techniques.
Key Words: coronary disease • tomography • revascularization
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