Correlation of myocardial histologic changes in hibernating myocardium with dobutamine stress echocardiographic findings,☆☆,

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Abstract

Objective: The objective of this study was to correlate histologic changes in hibernating myocardium with dobutamine stress echocardiography (DSE). Methods: Patients (n = 8) with anterior regional wall motion abnormalities in the seven echocardiographic segments representing the territory supplied by a significantly stenosed left anterior descending coronary artery had preoperative DSE performed (yielding 56 segments for analysis). Two transmural biopsy specimens were taken from the anterior wall of the left ventricle during coronary artery bypass grafting. Results: Morphometric histologic analysis of biopsy specimens showed significantly less fibrosis in segments demonstrating inotropic reserve (p < 0.05) and significantly less fibrosis in segments demonstrating improvement in wall motion on echocardiography 3 months after revascularization (p < 0.05). DSE had a sensitivity of 100% and a specificity of 62% for detection of hibernating myocardial segments. Percent fibrosis was inversely correlated with percent nucleated cells (r = 0.66, p < 0.01) and directly correlated with cytoplasmic clearance (r = 0.76, p < 0.01). Conclusion: Inotropic response during DSE correlates with histologic evidence of hibernating myocardium. (Am Heart J 1998;135:952-59.)

Section snippets

Background

Available data suggest that dobutamine stress echocardiography (DSE) is useful for the detection of “hibernating” myocardium (resting contractile dysfunction reversed by revascularization).1, 2, 3 The detection of contractile reserve by inotropic stimulation is the basis for the use of DSE to predict postrevascularization functional recovery. In patients with restriction of coronary blood flow at rest, the administration of dobutamine may cause a deterioration in myocardial dysfunction even at

General

Patients with known coronary artery disease (single, double, or triple vessel) with an occlusion or severe stenosis (>70%) on cine coronary angiography of the left anterior descending coronary artery and a corresponding wall motion abnormality on contrast ventriculography and transthoracic echocardiography (septum, anterior septum, anterior wall, and apex of the left ventricle) undergoing coronary artery bypass grafting were eligible for study. Patients with a myocardial infarct in the

Patient demographic and clinical features

Patient demographic and clinical features are outlined in Table I.

. Demographic and clinical features of the eight patients enrolled in the study

PatientJKSORHMHCYHCNMWJGJB
Age (yr)5667755661625764
Vessels diseaseDVDDVDDVDDVDDVDDVDTVDTVD
Ejection fraction %2520403530301545
Dyspnea class (CCS)24332322
Angina class (NYHA)32434343
History MINoYesYesNoNoYesYesYes
Anterior Q wavesYesNoNoNoNoNoYesYes

DVD, Double vessel disease; TVD, triple vessel disease; NYHA, New York Heart Association; MI, myocardial

Diagnostic accuracy of DSE for detection of hibernating myocardium

Myocardial segments demonstrating improvement in wall motion with low-dose dobutamine infusion have statistically significant less fibrosis than segments failing to demonstrate such reserve (Table II). This result confirms the theory that the response of dysfunctional myocardium is critically dependent on the quantity of residual contractile apparatus. Percent fibrosis was significantly less in the segments demonstrating improvement after revascularization (Table III). Therefore with the use of

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  • Cited by (0)

    From the Departments of aCardiology, bPathology, and cCardiac Surgery, Mater Misericordiae Hospital, D7.

    ☆☆

    Reprint requests: Terence Hennessy, MD, Transplant Unit, Regional Cardiac Unit, Papworth Hospital, Cambridge, CB3 8RE, England.

    4/1/89195

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