Myocardial Viability In Ischemic Cardiomyopathy Research Articles

Assessment of Myocardial Viability in Ischemic Cardiomyopathy With Reduced Left Ventricular Function Undergoing Coronary Artery Bypass Grafting.

We aim to provide a comprehensive review of the current state of knowledge of myocardial viability assessment in patients undergoing coronary artery bypass grafting (CABG), with a focus on the clinical markers of viability for each imaging modality. We also compare mortality between patients with viable myocardium and those without viability who undergo CABG. A systematic database search with meta-analysis was conducted of comparative original articles (both observations and randomized controlled studies) of patients undergoing CABG with either viable or nonviable myocardium, in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to 2022. Imaging modalities included were dobutamine stress echocardiography (DSE), cardiac magnetic resonance (CMR), single-photon emission computed tomography (SPECT), and positron emission tomography (PET). A total of 17 studies incorporating a total of 2317 patients were included. Across all imaging modalities, the relative risk of death post-CABG was reduced in patients with versus without viability (random-effects model: odds ratio: 0.42; 95% confidence interval: 0.29-0.61; p < 0.001). Imaging for myocardial viability has significant clinical implications as it can affect the accuracy of the diagnosis, guide treatment decisions, and predict patient outcomes. Generally, based on local availability and expertise, either SPECT or DSE should be considered as the first step in evaluating viability, while PET or CMR would provide further evaluation of transmurality, perfusion metabolism, and extent of scar tissue. The assessment of myocardial viability is an essential component of preoperative evaluation in patients with ischemic heart disease undergoing surgical revascularization. Careful patient selection and individualized assessment of viability remainparamount.

Assessment of Myocardial Viability in Ischemic Cardiomyopathy—Scarred by the Data but Still Alive

Assessment of Myocardial Viability in Ischemic Cardiomyopathy—Scarred by the Data but Still Alive

Value of 12-lead electrocardiogram to predict myocardial scar on FDG PET in heart failure patients

PurposeA surface 12-lead electrocardiogram (ECG) is widely available, fast, inexpensive, and safe. However, its value to predict a true myocardial scar in patients with ischemic cardiomyopathy (ICM) has not been studied extensively yet. This study was conducted to assess whether Q waves on resting surface 12-lead ECG are predictive of non-viable myocardium in patients with ICM. MethodsWe analyzed resting ECGs of 149 patients with ICM undergoing cardiac positron emission tomography (PET) with 13N-ammonia (NH3) and 18F-fluorodeoxyglucose (FDG) at our institution. Pathological Q waves and QS complexes were assigned to one of three coronary artery territories and compared to the PET findings. Myocardial scar was defined as 2 or more contiguous myocardial segments with an average (matched) reduction of NH3 and FDG uptake <50% of the maximum value. ResultsPathological Q waves had a sensitivity and specificity of 70% and 40%, respectively, and a PPV and NPV of 37% and 73%, respectively, to detect myocardial scar on FDG PET. For QS complexes, sensitivity and specificity were 46% and 59%, respectively, and PPV and NPV were 36% and 68%, respectively. Sensitivity was lower, but specificity was significantly higher in both the LCX and RCA compared to the LAD territory (p<0.001), particularly for QS complexes. ConclusionPathological Q waves on resting 12-lead ECG have poor or at best moderate sensitivity and specificity to detect myocardial scar on FDG PET. These findings support the use of more advanced imaging techniques to assess myocardial viability in ICM.

Accuracy of Two-Dimensional Speckle Tracking Echocardiography in Detection of Myocardial viability in Patients with Ischaemic Cardiomyopathy

Background: ischaemic cardiomyopathy isone of the common causes ofhigh mortality and increasing prevalence of heart failure. Because of the need to treat the cause of ischemic cardiomyopathy, testing of patients and detection of myocardial viability is much important and can help to identify viable segments of myocardium that have great chance of improving after revascularization. Noninvasive imaging are used for detection of viability and 2 dimensional speckle tracking echocardiography is under research for this. Aim of the work: Detection of myocardial viability in ischemic cardiomyopathy using 2D speckle tracking Echocardiography versus myocardial perfusion imaging. Patients and Methods: The ethical approval was obtained from the hospital ethical research committee and each patient entering the study signed an informed consent. Fifty patients included in this study with known ischemic cardiomyopathy. They were recruited from outpatient clinic at Al-Hussien Hospital during the period from October 2017 to July 2018. Myocardial perfusion imaging and 2D speckle tracking echocardiography with segmental longitudinal strain and global longitudinal strain were done to the fifty patients. Results: 2D speckle tracking echocardiography with segmental longitudinal strain and global longitudinal strain when compared with myocardial perfusion imaging predicted cutoff point for viable segment from nonviable with detected sensitivity and specificity. Conclusion: The new echocardiographically-derived myocardial deformation indices, which reflect structural changes assessed by transthoracic echocardiography can be used to detect myocardial viability.

Combination of contrast-enhanced cardiac MR and nuclear myocardial imaging in evaluation of myocardial viability in ischemic cardiomyopathy

Objective To explore the imaging characteristics and the complementarity of contrast- enhanced cardiac magnetic resonance CMR and nuclear myocardial perfusion/metabolic imaging in the evaluation of myocardial viability in patients with ischemic cardiomyopathy. Methods A total of 111 patients with diagnosed coronary artery disease and left ventricular dysfunction were retrospectively enrolled in this study. All patients underwent CMR and nuclear myocardial imaging within 1 month. Cine CMR was employed to evaluate cardiac function and wall motion. Contrast-enhanced CMR and myocardial perfusion/metabolic images were quantitatively assessed using a standard 17-segment and 5-score system. Dysfunctional segments were classified as viable or non- viable based on contrast- enhanced CMR and myocardial perfusion/metabolic imaging, respectively. No enhancement or sub-endocardial enhancement was defined as viable, while transmural enhancement was defined as non-viable. Severely matched perfusion/metabolism defects on nuclear imaging were assigned as non-viable while other patterns were considered as viable.Kappa index was calculated to evaluate the diagnostic concordance in assessing myocardial viability between contrast- enhanced CMR and myocardial perfusion/metabolic imaging. Results Among 1 887 segments in 111 patients, 80.3%(1 516/1 887) were dysfunctional. Of them, 63.3% (959/1 516) were viable and 36.7%(557/1 516) were non-viable on contrast-enhanced CMR, while 79.7%(1 208/1 516) were viable and 20.3% (308/1 516) were non-viable on nuclear myocardial imaging. The two modalities had a moderate concordance (Kappa=0.46, P<0.01). In segments with normal perfusion and metabolism, 73.9% (431/583) had various extent of enhancement but most of them(84.2%, 363/431) were subendocardial. On the other hand, 21.0% (117/557) segments with transmural enhancement had hibernating myocardium on nuclear imaging. Conclusions Contrast-enhanced CMR and nuclear myocardial imaging have a moderate concordance in the evaluation of myocardial viability in ischemic cardiomyopathy. Combination of the two modalities is expected to improve the diagnostic accuracy in assessing myocardial viability. Key words: Myocardium; Magnetic resonance imaging; Nuclear imaging; Myocardial ischemia

Relation between QT dispersion and myocardial viability in ischemic cardiomyopathy

The aim of this study was to evaluate the relation between QT dispersion and myocardial viability as assessed by single-photon emission computed tomography. The study population included 97 consecutive patients with severely impaired left ventricular function secondary to chronic coronary artery disease. Patients with a low QT dispersion had a substantial amount of viable myocardium, whereas patients with a high QT dispersion had predominantly nonviable scar tissue.