Document Detail


Dobutamine-induced contractile reserve in stunned, hibernating, and scarred myocardium in patients with ischemic cardiomyopathy.
MedLine Citation:
PMID:  12571199     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Because of damage to cardiomyocytes and the contractile apparatus, contractile reserve may be observed less frequently in hibernating than in stunned myocardium. The aim of this study was to assess the presence of contractile reserve in response to dobutamine infusion in a large group of patients with stunned and hibernating myocardium. METHODS: A total of 198 consecutive patients with ischemic cardiomyopathy (left ventricular ejection fraction < or = 40%) underwent resting 2-dimensional echocardiography to assess regional contractile dysfunction. On the basis of assessment of perfusion (with (99m)Tc-tetrofosmin SPECT) and glucose use (with (18)F-FDG SPECT), dysfunctional segments were grouped. Dysfunctional segments with normal perfusion were classified as stunned. Dysfunctional segments with a perfusion defect were classified as hibernating when a perfusion-(18)F-FDG mismatch was present. Dysfunctional segments with a perfusion defect were classified as scar tissue when a perfusion-(18)F-FDG match was present; these segments were subdivided into nontransmural and transmural scars. Contractile reserve was evaluated by dobutamine stress echocardiography. RESULTS: Dobutamine-induced contractile reserve was more frequently found in stunned than in hibernating myocardium (61% vs. 51%, respectively; P < 0.01). Only 14% of the scarred segments improved in wall motion during dobutamine infusion, significantly less than stunned or hibernating myocardium (P < 0.001). Nontransmural scars exhibited contractile reserve more frequently than did transmural scars. CONCLUSION: The progressive reduction of contractile reserve in stunned, hibernating, and scarred myocardium supports the hypothesis that stunning, hibernation, and scarring are not circumscript pathophysiologic entities but represent gradual ultrastructural damage on the myocyte level.
Authors:
Arend F L Schinkel; Jeroen J Bax; Ron van Domburg; Abdou Elhendy; Roelf Valkema; Eleni C Vourvouri; Fabiola B Sozzi; Jos R T C Roelandt; Don Poldermans
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Journal of nuclear medicine : official publication, Society of Nuclear Medicine     Volume:  44     ISSN:  0161-5505     ISO Abbreviation:  J. Nucl. Med.     Publication Date:  2003 Feb 
Date Detail:
Created Date:  2003-02-06     Completed Date:  2003-03-18     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0217410     Medline TA:  J Nucl Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  127-33     Citation Subset:  IM    
Affiliation:
Thoraxcenter, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Dobutamine / diagnostic use*,  pharmacology*
Echocardiography
Female
Fluorodeoxyglucose F18 / diagnostic use
Heart / drug effects,  radionuclide imaging*
Humans
Male
Middle Aged
Myocardial Contraction / drug effects*
Myocardial Infarction / radionuclide imaging*,  ultrasonography
Myocardial Ischemia / radionuclide imaging*,  ultrasonography
Myocardial Stunning / classification,  radionuclide imaging*,  ultrasonography
Organophosphorus Compounds / diagnostic use
Organotechnetium Compounds / diagnostic use
Radiopharmaceuticals / diagnostic use
Single-Blind Method
Stress, Physiological / chemically induced
Tomography, Emission-Computed, Single-Photon
Ventricular Dysfunction, Left / radionuclide imaging,  ultrasonography
Chemical
Reg. No./Substance:
0/Organophosphorus Compounds; 0/Organotechnetium Compounds; 0/Radiopharmaceuticals; 0/technetium Tc 99m 1,2-bis(bis(2-ethoxyethyl)phosphino)ethane; 34368-04-2/Dobutamine; 63503-12-8/Fluorodeoxyglucose F18

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