Relation of the contractile reserve of hibernating myocardium to myocardial structure in humans

Although dobutamine echocardiography (DE) is widely used to assess myocardial viability in humans, little is known about the relation between contractile reserve and myocardial structure. We evaluated 20 patients with coronary disease (64+/-13 years old, ejection fraction 28+/-7.5%) with DE (up to 4...

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Published in:Circulation (New York, N.Y.) N.Y.), 1999-08, Vol.100 (5), p.490-496
Main Authors: NAGUEH, S. F, MIKATI, I, ESPADA, R, VERANI, M. S, ZOGHBI, W. A, WEILBAECHER, D, REARDON, M. J, AL-ZAGHRINI, G. J, CACELA, D, HE, Z.-X, LETSOU, G, NOON, G, HOWELL, J. F
Format: Article
Language:English
Subjects:
Adrenergic beta-Agonists
Adult
Aged
Biological and medical sciences
Cardiovascular system
Coronary Angiography
Coronary Artery Bypass
Coronary Disease - diagnostic imaging
Coronary Disease - pathology
Coronary Disease - physiopathology
Coronary Disease - surgery
Dobutamine
Echocardiography - methods
Female
Fibronectins - analysis
Fibrosis
Heart - diagnostic imaging
Heart - physiopathology
Humans
Immunohistochemistry
Investigative techniques, diagnostic techniques (general aspects)
Male
Medical sciences
Middle Aged
Myocardial Contraction
Myocardium - chemistry
Myocardium - metabolism
Myocardium - pathology
Thallium Radioisotopes
Tomography, Emission-Computed, Single-Photon
Ultrasonic investigative techniques
Vimentin - analysis
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Summary:Although dobutamine echocardiography (DE) is widely used to assess myocardial viability in humans, little is known about the relation between contractile reserve and myocardial structure. We evaluated 20 patients with coronary disease (64+/-13 years old, ejection fraction 28+/-7.5%) with DE (up to 40 micrograms . kg(-1). min(-1)), rest-redistribution (201)Tl single photon emission CT, and quantitative angiography before bypass surgery. During surgery, patients underwent transmural myocardial biopsies (n=37) guided by transesophageal echocardiography to determine the extent of interstitial fibrosis and intracellular and interstitial proteins by histopathology and immunohistochemistry. Among the 37 segments biopsied, 16 recovered function as assessed 2 to 3 months later. Segments with postoperative functional recovery had more wall thickening at low-dose DE (28% versus 3%, P
ISSN:0009-7322
1524-4539
DOI:10.1161/01.CIR.100.5.490