Document Detail


Pathophysiology and diagnosis of hibernating myocardium in patients with post-ischemic heart failure: the contribution of PET.
MedLine Citation:
PMID:  12971630     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Identification and treatment of hibernating myocardium (HM) lead to improvement in LV function and prognosis in patients with post-ischemic heart failure. Different techniques are used to diagnose HM: echocardiography, MRI, SPECT and PET and, in patients with moderate LV impairment, their predictive values are similar. There are few data on patients with severe LV dysfunction and heart failure in whom the greatest benefits are apparent after revascularization. Quantification of FDG uptake with PET during hyperinsulinemic euglycemic clamp is accurate in these patients with the greatest mortality risk in whom other techniques may give high false negative rates. The debate on whether resting myocardial blood flow to HM is reduced or not has stimulated new research on heart failure in patients with coronary artery disease. PET with H2(15)O or 13NH3 has been used for the absolute quantification of regional blood flow in human HM. When HM is properly identified, resting blood flow is not different from that in healthy volunteers although a reduction of approximately 20% can be demonstrated in a minority of cases. PET studies have shown that the main feature of HM is a severe impairment of coronary vasodilator reserve that improves after revascularization in parallel with LV function. Thus, the pathophysiology of HM is more complex than initially postulated. The recent evidence that repetitive ischemia in patients can be cumulative and lead to more severe and prolonged stunning, lends further support to the hypothesis that, at least initially, stunning and HM are two facets of the same coin.
Authors:
Paolo G Camici; Ornella E Rimoldi
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Annals of nuclear medicine     Volume:  17     ISSN:  0914-7187     ISO Abbreviation:  Ann Nucl Med     Publication Date:  2003 Jul 
Date Detail:
Created Date:  2003-09-15     Completed Date:  2003-12-04     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8913398     Medline TA:  Ann Nucl Med     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  341-50     Citation Subset:  IM    
Affiliation:
MRC Clinical Sciences Centre and National Heart and Lung Institute, Faculty of Medicine, Imperial College of Science, Technology and Medicine, Hammersmith Hospital, London, United Kingdom. paolo.camici@csc.mrc.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Blood Flow Velocity
Coronary Circulation*
Coronary Vessels / metabolism,  physiopathology,  radionuclide imaging
Fluorodeoxyglucose F18 / diagnostic use*,  pharmacokinetics*
Glucose / metabolism*
Heart / physiopathology,  radionuclide imaging
Heart Failure / complications,  metabolism,  physiopathology,  radionuclide imaging
Humans
Myocardial Ischemia / complications,  metabolism,  physiopathology,  radionuclide imaging
Myocardial Stunning / etiology,  metabolism,  physiopathology*,  radionuclide imaging*
Myocardium / metabolism
Radiopharmaceuticals / diagnostic use,  pharmacokinetics
Tomography, Emission-Computed / methods*
Chemical
Reg. No./Substance:
0/Radiopharmaceuticals; 50-99-7/Glucose; 63503-12-8/Fluorodeoxyglucose F18

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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