Document Detail

Resting myocardial blood flow, coronary flow reserve, and contractile reserve in hibernating myocardium: implications for using resting myocardial contrast echocardiography vs. dobutamine echocardiography for the detection of hibernating myocardium.
MedLine Citation:
PMID:  20488815     Owner:  NLM     Status:  In-Process    
AIMS: Controversy exists regarding the relative status of resting myocardial blood flow (MBF), coronary flow reserve (CFR), and contractile reserve (CR) in hibernating myocardium (HM). We hypothesized that CFR is more profoundly affected than resting MBF parameters in HM. Thus, resting MBF assessed by myocardial contrast echocardiography (MCE) will be more sensitive than CR elicited by dobutamine stress echocardiography (DSE) for the detection of HM.
METHODS AND RESULTS: Accordingly 27 patients with ischaemic cardiomyopathy underwent resting MCE and DSE prior to revascularisation, of which 23 patients underwent follow-up echocardiography at 179 ± 66 days after revascularization. Qualitative and quantitative MCE [contrast intensity (A, dB)], MBF (represented by blood velocity β, dB/s), and CFR (vasodilator β/rest β, β reserve) were obtained. CR was obtained during DSE. Resting contrast intensity (7.2 ± 2.3 dB) and β (0.67 ± 0.47 dB/s) were significantly (P < 0.005 and <0.01, respectively) reduced in HM vs. remote normal myocardium but significantly higher compared with non-viable segments (4.4 ± 2.3 dB and 0.43 ± 0.32 dB/s, respectively). However, CFR was significantly (0.82 ± 3.2 (P = 0.01)) lower in HM compared with normal (1.8 ± 1.02) but not significantly reduced when compared with non-viable myocardium (1.1 ± 3.3). Sensitivity for the detection of HM with qualitative and quantitative MCE were 82 and 87%, respectively, compared with 67% (P < 0.0001) by DSE with similar specificity of 55 and 67%, respectively, compared with 63% with DSE.
CONCLUSION: Resting MBF but not CFR distinguished HM from non-viable myocardium. Resting MCE and not DSE was more accurate for the prediction of HM.
Michael Hickman; Rajesh Chelliah; Leah Burden; Roxy Senior
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-05-20
Journal Detail:
Title:  European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology     Volume:  11     ISSN:  1532-2114     ISO Abbreviation:  Eur J Echocardiogr     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100890618     Medline TA:  Eur J Echocardiogr     Country:  England    
Other Details:
Languages:  eng     Pagination:  756-62     Citation Subset:  IM    
Department of Cardiology, Northwick Park Hospital, Harrow HA1 3UJ, UK.
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