This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Shivalkar, B. Articles by Flameng, W. Search for Related Content PubMed PubMed Citation Articles by Shivalkar, B. Articles by Flameng, W.

(Circulation. 1996;94:308-315.)
© 1996 American Heart Association, Inc.

Articles

Only Hibernating Myocardium Invariably Shows Early Recovery After Coronary Revascularization

Bharati Shivalkar, MD; Alex Maes, MD; Marcel Borgers, PhD; Jannie Ausma, MSc; Ilse Scheys, PhD; Johan Nuyts, PhD; Luc Mortelmans, MD; Willem Flameng, MD

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

This article has been cited by other articles:

				C. Y. Kim, H. Y. Hwang, J. C. Paeng, D. S. Lee, and K.-B. Kim Improved myocardial perfusion and thickening after off-pump revascularization: 5-year follow-up. Ann. Thorac. Surg., November 1, 2009; 88(5): 1419 - 1425. [Abstract] [Full Text] [PDF]

				O. Bondarenko, A. M. Beek, J. W.R. Twisk, C. A. Visser, and A. C. van Rossum Time course of functional recovery after revascularization of hibernating myocardium: a contrast-enhanced cardiovascular magnetic resonance study Eur. Heart J., August 2, 2008; 29(16): 2000 - 2005. [Abstract] [Full Text] [PDF]

				M. A. Soliman Hamad, M. E. S.H. Tan, A. H.M. van Straten, A. A.J. van Zundert, and J. P.A.M. Schonberger Long-Term Results of Coronary Artery Bypass Grafting in Patients With Left Ventricular Dysfunction Ann. Thorac. Surg., February 1, 2008; 85(2): 488 - 493. [Abstract] [Full Text] [PDF]

				A. Angelini, G. Maiolino, G. La Canna, C. Ceconi, F. Calabrese, E. Pettenazzo, M. Valente, O. Alfieri, G. Thiene, and R. Ferrari Relevance of apoptosis in influencing recovery of hibernating myocardium Eur J Heart Fail, April 1, 2007; 9(4): 377 - 383. [Abstract] [Full Text] [PDF]

				V. Bito, J. van der Velden, P. Claus, C. Dommke, A. Van Lommel, L. Mortelmans, E. Verbeken, B. Bijnens, G. Stienen, and K. R. Sipido Reduced Force Generating Capacity in Myocytes From Chronically Ischemic, Hibernating Myocardium Circ. Res., February 2, 2007; 100(2): 229 - 237. [Abstract] [Full Text] [PDF]

				S C Chua, R H Ganatra, D J Green, and A M Groves Nuclear cardiology: myocardial perfusion imaging with SPECT and PET Imaging, September 1, 2006; 18(3): 166 - 177. [Abstract] [Full Text] [PDF]

				M. Hendrikx, K. Hensen, C. Clijsters, H. Jongen, R. Koninckx, E. Bijnens, M. Ingels, A. Jacobs, R. Geukens, P. Dendale, et al. Recovery of Regional but Not Global Contractile Function by the Direct Intramyocardial Autologous Bone Marrow Transplantation: Results From a Randomized Controlled Clinical Trial Circulation, July 4, 2006; 114(1_suppl): I-101 - I-107. [Abstract] [Full Text] [PDF]

				S. F. Vatner FGF Induces Hypertrophy and Angiogenesis in Hibernating Myocardium Circ. Res., April 15, 2005; 96(7): 705 - 707. [Full Text] [PDF]

				G. Heusch, R. Schulz, and S. H. Rahimtoola Myocardial hibernation: a delicate balance Am J Physiol Heart Circ Physiol, March 1, 2005; 288(3): H984 - H999. [Abstract] [Full Text] [PDF]

				F Alamanni, A Parolari, A Repossini, E Doria, F Bortone, J Campolo, M Pepi, E Sisillo, M Naliato, R Bigi, et al. Coronary blood flow, metabolism, and function in dysfunctional viable myocardium before and early after surgical revascularisation Heart, November 1, 2004; 90(11): 1291 - 1298. [Abstract] [Full Text] [PDF]

				G S Werner, U Emig, P Bahrmann, M Ferrari, and H R Figulla Recovery of impaired microvascular function in collateral dependent myocardium after recanalisation of a chronic total coronary occlusion Heart, November 1, 2004; 90(11): 1303 - 1309. [Abstract] [Full Text] [PDF]

				H. S. Maniar, B. P. Cupps, D. D. Potter, P. Moustakidis, C. J. Camillo, C. M. Chu, M. K. Pasque, and T. M. Sundt III Ventricular function after coronary artery bypass grafting: Evaluation by magnetic resonance imaging and myocardial strain analysis J. Thorac. Cardiovasc. Surg., July 1, 2004; 128(1): 76 - 82. [Abstract] [Full Text] [PDF]

				S.R. Underwood, J. J Bax, J. v. Dahl, M. Y Henein, A. C van Rossum, E. R Schwarz, J.-L. Vanoverschelde, E. E.v. d. Wall, and W. Wijns Imaging techniques for the assessment of myocardial hibernation: Report of a Study Group of the European Society of Cardiology Eur. Heart J., May 2, 2004; 25(10): 815 - 836. [Abstract] [Full Text] [PDF]

				V. Bito, F. R. Heinzel, F. Weidemann, C. Dommke, J. van der Velden, E. Verbeken, P. Claus, B. Bijnens, I. De Scheerder, G. J.M. Stienen, et al. Cellular Mechanisms of Contractile Dysfunction in Hibernating Myocardium Circ. Res., April 2, 2004; 94(6): 794 - 801. [Abstract] [Full Text] [PDF]

				D. A Gorog, M. Tanno, X. Cao, M. Bellahcene, R. Bassi, A. M.N Kabir, K. Dighe, R. A Quinlan, and M. S Marber Inhibition of p38 MAPK activity fails to attenuate contractile dysfunction in a mouse model of low-flow ischemia Cardiovasc Res, January 1, 2004; 61(1): 123 - 131. [Abstract] [Full Text] [PDF]

				K. C. Wu and J. A.C. Lima Noninvasive Imaging of Myocardial Viability: Current Techniques and Future Developments Circ. Res., December 12, 2003; 93(12): 1146 - 1158. [Abstract] [Full Text] [PDF]

				T. Murashita, Y. Makino, Y. Kamikubo, K. Yasuda, M. Mabuchi, and N. Tamaki Quantitative gated myocardial perfusion single photon emission computed tomography improves the prediction of regional functional recovery in akinetic areas after coronary bypass surgery: useful tool for evaluation of myocardial viability J. Thorac. Cardiovasc. Surg., November 1, 2003; 126(5): 1328 - 1334. [Abstract] [Full Text] [PDF]

				C. Ceconi, G. La Canna, O. Alfieri, A. Cargnoni, G. Coletti, S. Curello, M. Zogno, G. Parrinello, S. H. Rahimtoola, and R. Ferrari Revascularization of hibernating myocardium. Rate of metabolic and functional recovery and occurrence of oxidative stress Eur. Heart J., December 1, 2002; 23(23): 1877 - 1885. [Abstract] [Full Text] [PDF]

				R. Lorusso, G. La Canna, C. Ceconi, V. Borghetti, P. Totaro, G. Parrinello, G. Coletti, and G. Minzioni Long-term results of coronary artery bypass grafting procedure in the presence of left ventricular dysfunction and hibernating myocardium Eur. J. Cardiothorac. Surg., November 1, 2001; 20(5): 937 - 948. [Abstract] [Full Text] [PDF]

				J. J. Bax, F. C. Visser, D. Poldermans, A. Elhendy, J. H. Cornel, E. Boersma, A. van Lingen, P. M. Fioretti, and C. A. Visser Time Course of Functional Recovery of Stunned and Hibernating Segments After Surgical Revascularization Circulation, September 18, 2001; 104 (2009): I-314 - I-318. [Abstract] [Full Text] [PDF]

				A. Maes, P. Mertens, and G.R. Sutherland What is the role of cardiac PET in patients with ischaemic heart disease and significant left ventricular dysfunction? Eur. Heart J., September 2, 2001; 22(18): 1629 - 1631. [PDF]

				M. Chello, P. Mastroroberto, F. Perticone, F. Cirillo, E. Bevacqua, S. Olivito, and E. Covino Plasma levels of atrial and brain natriuretic peptides as indicators of recovery of left ventricular systolic function after coronary artery bypass Eur. J. Cardiothorac. Surg., July 1, 2001; 20(1): 140 - 146. [Abstract] [Full Text] [PDF]

				P. G. Camici and D. P. Dutka Repetitive stunning, hibernation, and heart failure: contribution of PET to establishing a link Am J Physiol Heart Circ Physiol, March 1, 2001; 280(3): H929 - H936. [Full Text] [PDF]

				H. Wiggers, M. Noreng, P. K. Paulsen, M. Bottcher, H. Egeblad, T. T. Nielsen, and H. E. Botker Energy stores and metabolites in chronic reversibly and irreversibly dysfunctional myocardium in humans J. Am. Coll. Cardiol., January 1, 2001; 37(1): 100 - 108. [Abstract] [Full Text] [PDF]

				A. Tawakol and H. Gewirtz Does CABG Improve Left Ventricular Ejection Fraction in Patients with Ischemic Cardiomyopathy, and Does It Matter? J. Nucl. Med., January 1, 2001; 42(1): 87 - 0. [Full Text] [PDF]

				T. M. Casey and P. G. Arthur Hibernation in Noncontracting Mammalian Cardiomyocytes Circulation, December 19, 2000; 102(25): 3124 - 3129. [Abstract] [Full Text] [PDF]

				D. Pagano, P.G. Camici, S. F. Nagueh, I. Mikati, D. Weilbaecher, M. J. Reardon, G. J. Al-Zaghrini, D. Cacela, Z.-X. He, G. Letsou, et al. Relation of Contractile Reserve of Hibernating Myocardium to Myocardial Structure in Humans Response Circulation, December 19, 2000; 102 (25): e189 - e190. [Full Text] [PDF]

				A. Tawakol, H. A. Skopicki, S. A. Abraham, N. M. Alpert, A. J. Fischman, M. H. Picard, and H. Gewirtz Evidence of reduced resting blood flow in viable myocardial regions with chronic asynergy J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2146 - 2153. [Abstract] [Full Text] [PDF]

				R Schulz and G Heusch Hibernating myocardium Heart, December 1, 2000; 84(6): 587 - 594. [Full Text]

				J. A. Fallavollita Spatial Heterogeneity in Fasting and Insulin-Stimulated 18F-2-Deoxyglucose Uptake in Pigs With Hibernating Myocardium Circulation, August 22, 2000; 102(8): 908 - 914. [Abstract] [Full Text] [PDF]

				G LaCanna, S.H Rahimtoola, O Visioli, R Giubbini, O Alfieri, M Zognio, E Milan, C Ceconi, M Gargano, R LoRusso, et al. Sensitivity, specificity, and predictive accuracies of non-invasive tests, singly and in combination, for diagnosis of hibernating myocardium Eur. Heart J., August 2, 2000; 21(16): 1358 - 1367. [Abstract] [PDF]

				D Pagano, J N Townend, D V Parums, R S Bonser, and P G Camici Hibernating myocardium: morphological correlates of inotropic stimulation and glucose uptake Heart, April 1, 2000; 83(4): 456 - 461. [Abstract] [Full Text]

				G. D. Dispersyn, M. Borgers, and W. Flameng Apoptosis in chronic hibernating myocardium: sleeping to death? Cardiovasc Res, February 1, 2000; 45(3): 696 - 703. [Abstract] [Full Text] [PDF]

				B. Shivalkar, W. Flameng, M. Szilard, S. Pislaru, M. Borgers, and J. Vanhaecke Repeated stunning precedes myocardial hibernation in progressive multiple coronary artery obstruction J. Am. Coll. Cardiol., December 1, 1999; 34(7): 2126 - 2136. [Abstract] [Full Text] [PDF]

				H. Samady, J. A. Elefteriades, B. G. Abbott, J. A. Mattera, C. A. McPherson, and F. J. Th. Wackers Failure to Improve Left Ventricular Function After Coronary Revascularization for Ischemic Cardiomyopathy Is Not Associated With Worse Outcome Circulation, September 21, 1999; 100(12): 1298 - 1304. [Abstract] [Full Text] [PDF]

				F Fath-Ordoubadi, K J Beatt, N Spyrou, and P G Camici Efficacy of coronary angioplasty for the treatment of hibernating myocardium Heart, August 1, 1999; 82(2): 210 - 216. [Abstract] [Full Text] [PDF]

				H. Schoder, R. Campisi, T. Ohtake, C. K. Hoh, D. H. Moon, J. Czernin, and H. R. Schelbert Blood flow-metabolism imaging with positron emission tomography in patients with diabetes mellitus for the assessment of reversible left ventricular contractile dysfunction J. Am. Coll. Cardiol., April 1, 1999; 33(5): 1328 - 1337. [Abstract] [Full Text] [PDF]

				E. R. Schwarz, T. Reffelmann, F. Schoendube, B. Herrmanns, R. Chakupurakal, H. Doerge, T. Schuetz, M. Foresti, B. J. Messmer, P. W. Radke, et al. Hypoxic Hypoperfusion Fails to Induce Myocardial Hibernation in Anesthetized Swine Journal of Cardiovascular Pharmacology and Therapeutics, January 1, 1999; 4(4): 235 - 247. [Abstract] [PDF]

				G. HEUSCH Hibernating Myocardium Physiol Rev, October 1, 1998; 78(4): 1055 - 1085. [Abstract] [Full Text] [PDF]

				R. K. Kudej, B. Ghaleh, N. Sato, Y.-T. Shen, S. P. Bishop, and S. F. Vatner Ineffective Perfusion-Contraction Matching in Conscious, Chronically Instrumented Pigs With an Extended Period of Coronary Stenosis Circ. Res., June 15, 1998; 82(11): 1199 - 1205. [Abstract] [Full Text] [PDF]

				R. A. Kloner, R. Bolli, E. Marban, L. Reinlib, and E. Braunwald Medical and Cellular Implications of Stunning, Hibernation, and Preconditioning : An NHLBI Workshop Circulation, May 19, 1998; 97(18): 1848 - 1867. [Full Text] [PDF]

				M. C. Schaub, M. A. Hefti, R. A. Zuellig, and I. Morano Modulation of contractility in human cardiac hypertrophy by myosin essential light chain isoforms Cardiovasc Res, February 1, 1998; 37(2): 381 - 404. [Abstract] [Full Text] [PDF]

				W. J. Flameng, B. Shivalkar, B. Spiessens, A. Maes, J. Nuyts, J. VanHaecke, and L. Mortelmans PET Scan Predicts Recovery of Left Ventricular Function After Coronary Artery Bypass Operation Ann. Thorac. Surg., December 1, 1997; 64(6): 1694 - 1701. [Abstract] [Full Text]

				G. Heusch, R. Ferrari, D. J Hearse, T. J.C Ruigrok, and R. Schulz 'Myocardial hibernation'--questions and controversies Cardiovasc Res, December 1, 1997; 36(3): 301 - 309. [Full Text] [PDF]

				J. A. Fallavollita, B. J. Perry, and J. M. Canty Jr 18F-2-Deoxyglucose Deposition and Regional Flow in Pigs With Chronically Dysfunctional Myocardium : Evidence for Transmural Variations in Chronic Hibernating Myocardium Circulation, April 1, 1997; 95(7): 1900 - 1909. [Abstract] [Full Text]

				J.-L. J. Vanoverschelde, W. Wijns, M. Borgers, G. Heyndrickx, C. Depre, W. Flameng, and J. A. Melin Chronic Myocardial Hibernation in Humans: From Bedside to Bench Circulation, April 1, 1997; 95(7): 1961 - 1971. [Full Text]

				S. H. Rahimtoola Hibernating Myocardium Has Reduced Blood Flow at Rest That Increases With Low-Dose Dobutamine Circulation, December 15, 1996; 94(12): 3055 - 3061. [Full Text]

				J. A. Fallavollita and J. M. Canty Jr. Ischemic cardiomyopathy in pigs with two-vessel occlusion and viable, chronically dysfunctional myocardium Am J Physiol Heart Circ Physiol, April 1, 2002; 282(4): H1370 - H1379. [Abstract] [Full Text] [PDF]

				E. Barnes, D. P. Dutka, M. Khan, P. G. Camici, and R. J. Hall Effect of repeated episodes of reversible myocardial ischemia on myocardial blood flow and function in humans Am J Physiol Heart Circ Physiol, May 1, 2002; 282(5): H1603 - H1608. [Abstract] [Full Text] [PDF]