DOCSLIB.ORG

Detection of Myocardial Viability with Positron Emission Tomography in a Patient with Ischemic Cardiomyopathy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Detection of Myocardial Viability with Positron Emission Tomography in a Patient with Ischemic Cardiomyopathy Detection of Myocardial Viability with Positron Emission Tomography in a Patient with Ischemic Cardiomyopathy Case Presentation: David Weiss Discussion: Howard J. Eisen Guest Editor: Abass Alavi Nuclear Medicine Division, Department ofRadiology and the Cardiovascular Section, Department of Medicine, Hospital ofthe University ofPennsylvania, Philadelphia, Pennsylvania Physical exam revealed a blood pressure of 100/60 J NucI Med 1991; 32:130—135 and a regular pulse of 100. Sharp discs were present on fundiscopic exam with no arteriovenous nicking. Ca rotid artery pulseswere normal with no bruits, and no CASEPRESENTATION jugular venous distention was present. The lungs were clear to auscultation and percussion. Cardiac exam A 52-yr-old man became unresponsive while riding revealed a regular rate, a soft Il/VI systolic ejection in a van driven by his son in August 1989. The son murmur at the lower sternal border, and the presence stopped the van, found the patient to be without spon of an S4. No S3 was heard. Abdominal exam was taneous respirations or pulse, and started cardiopul remarkablefor slight hepatomegaly.The spleenwasnot monary resuscitation. He was aided by a passerby, but enlarged. No peripheral edema, cyanosis, or clubbing approximately 30—45mm elapsed before spontaneous was present. respirations returned. Enroute to a nearby hospital, the Electrocardiographic findings included sinus tachy patient was described as being cyanotic with a very cardia with evidence of right atrial enlargement. Left weak pulse. In the emergency room, the patient was axis deviation was present and poor R-wave progression lethargic, and later combative, agitated, and confused. across the precordium was noted. No Q-waves, ST Premature ventricular contractions were noted and, segment, or T-wave abnormalities were present. therefore, a lidocaine infusion was started. Laboratory evaluation upon admission revealed a The patient had reportedly been in good health until creatine kinase of 18, LDH of 367, and glucose of 766. approximately 6 wk prior to admission when he had The arterial blood gases on a 100% rebreathing mask presented with slurred speech and personality changes. were as follows: pH 7.31, p02 of 186, and pCO2 of 28. Computed tomography of the head performed on Au Cardiac enzymes obtained following admission showed gust 24, 1989 revealed a hemorrhagic left parietal in no evidence of an acute myocardial infarction. Chest farct, which wastreatedconservatively.The neurologic ifim revealed no evidence ofheart failure, with a mildly signs improved over a period of 3 wk with the only enlarged and somewhat globular appearing cardiac sil residual being a minimal expressive aphasia. Diabetes houette. A radionucide ventriculogram revealed a mellitus had also been discovered during this hospital markedly diminished left ventricular ejection fraction admission. of2O%, biventricular enlargement, apical akinesis, and His family history was significant in that his mother severe hypokinesis of the left ventricle. died at age 52 due to heart disease; a sister also had Echocardiography on August 24, 1989 confirmed a coronary artery disease. The patient had a smoking significantly low left ventricular ejection fraction of history ofhalfa pack per week, but had quit 5 mo prior 20%. Biventricular enlargement was present along with to admission. A history ofalcohol abuse in the past was a probable intracardiac thrombus along the septal wall. reported, but recent use was denied. Heart valves were structurally normal. Hemodynamics assessed at cardiac catheterization ReceivedNov.2, 1990;acceptedNov.2, 1990. on August 28, 1989 were remarkable for an elevated For reprintscontact:HowardJ. Eisen,MD. CardiovascularSection, Hospitalof the thversity of PennSylvania,9 Gates Bldg., 3400 Spruce St., mean pulmonary capillary wedge pressure of3O mmHg, Philadelphia,PA19104. elevated right heart pressures consistent with pulmo 130 The Journal of Nuclear Medicine •Vol. 32 •No. 1 •January 1991 @ :@@@:‘ nary hypertension and a diminished cardiac output of 2.99 liters per minute. Cardiac index was 1.47 liters per minute per meter squared. The left ventricular end diastolic pressurewas elevated at 30 mmHg. The arte riovenous02 difference was markedly elevated at 11.3 U) ‘/ vol%. Left ventricular ejection fraction was estimated to be l0%—l5% with globally decreased left ventricular wall motion. Three-vesselcoronaryartery diseasewasdocumented with a 90% stenosis just proximal to the first acute marginal branch of the right coronary artery, a short, diffusely narrowed left main coronary artery, and a tight occlusionbetween the first septalbranch and the first diagonal branch of the left anterior descending (LAD) coronary artery. The LAD lesion appeared to be a total occlusion which had recanalized. A 90% stenosis of the first obtuse marginal branch of the circumflex artery was present at the vessel origin, and a 50% .@)7B) segmental occlusion of the circumflex was noted dis FIGURE 1 tally. Stress and rest thallium scintigrams show an anterior and The impression at the time of the cardiac catheteri upper septal defect with no redistribution.Other regions of zation was that of severe three-vessel coronary artery the myocardiumshow thalliumuptake. disease with a low output state due to severe biventri cular failure. On the basis ofthese findings, the patient's heart disease was termed end-stage and he was not left ventricle with fixed defects in the anterior and upper considereda candidate for coronary artery bypasssur septal walls, most consistent with scar (Fig. 1). Radio gery. nuclide gated ventriculography done on the same day A tomographic thallium study was then performed demonstrated dilated ventricles, a left ventricular ejec following cardiac pacing on September 7, 1989. The tion fraction of 13%, and global left ventricular hypo patient's heart was paced to 87% of predicted maxi kinesis with akinetic septum and anteroapical walls. On mum. A large defect was present on the immediate the basis of these findings and the attendant intraoper images involving the septum, apex, and inferior wall. ative and perioperative risk of bypass grafting in this Dilatation of the left ventricle was noted on the imme setting, coronary artery bypass graft (CABG) surgery diate post-pacing images. The delayed study revealed was not considered prudent. However, metabolic im the defects to be largely fixed with only slight improve aging was considered to further define the viability of ment in a small portion of the anteroseptal wall. the myocardium. Electrophysiologic studies were performed but no Positron emission tomography (PET) of the heart arrhythmia could be induced. The patient was anti was performed utilizing 10.5 mCi of fluorine-18-la coagulated for the cardiac thrombus. The patient was beled-2-fluoro-2-deoxyglucose(FDG) with the patient transferred to the Hospital of the University of Penn in a fasting state. One hundred grams ofan oral glucose sylvania (HUP) on September 18, 1989 for possible solution was administered orally 1hr prior to injection. cardiac transplantation and placement of an automatic Reconstructed tomographic images revealed normal implantable cardiac defibrillator (AICD). uptake of FDG in both the inferoapical region and in The admitting diagnosis at HUP was dilated cardio the septum, suggesting myocardial viability or “hiber myopathy, most likely ischemic in nature, with proba nating―myocardium (Fig. 2). With this additional in ble associated malignant ventricular arrhythmias and formation, bypass grafting was undertaken with grafts an episode of sudden cardiac death. Admitting chest placedfrom the aorta to the LAD, first obtusemarginal film confirmed the presence of a mildly enlarged heart branch, and from the aorta to the first acute marginal, without evidence of congestive heart failure. Carotid second acute marginal, and the distal right coronary Doppler examination revealed no significant stenoses. artery. In addition, patches were inserted for the even Electrophysiologicstudies were repeated with the in tual placement of an AICD. duction of a monomorphic ventricular tachycardia. Postoperative radionuclide gated ventriculography A stress-rest thallium study was performed on Sep was performed on October 6, 1989 and showed a tember 22, 1989 and the patient achieved 60% of marked improvement in left ventricular ejection frac maximal predicted heart rate with no ischemic electro tion to 36%. Septal and apical wall motion abnormali cardiographicfindings. Scintigraphy revealed a dilated ties persisted but were also substantially improved. Post Detecting Myocardial Viability •Weiss et al 131 viability. Indirect assessments of viability have relied on global as well as regional left ventricular function and wall motion. Such assessments in the past have been made using contrast or radionuclide angiography or echocardiography. Left ventricular segments that were akinetic, dyskinetic, or severely hypokinetic were felt to be infarcted zones that had little myocardial viability. Exercise-stress tests with thallium-20 1 (201Tl) scintigraphy have provided an improved method of discriminating ischemic but viable myocardium from irreversibly damaged necrotic myocardium (1—3).It has become apparent from prior studies that regional yen tricular wall asynergy or dysnergy does not provide accurate evidence for myocardial viability and that Transaxialslices of PET scan with [18F]FDG.Note homoge dysnergic or asynergic ventricular wall may contain neous
Load more

Recommended publications
  • Dobutamine-Induced Contractile Reserve in Stunned, Hibernating, and Scarred Myocardium in Patients with Ischemic Cardiomyopathy
    CLINICAL INVESTIGATIONS Dobutamine-Induced Contractile Reserve in Stunned, Hibernating, and Scarred Myocardium in Patients with Ischemic Cardiomyopathy Arend F.L. Schinkel, MD, PhD1; Jeroen J. Bax, MD, PhD2; Ron van Domburg, PhD1; Abdou Elhendy, MD, PhD1; Roelf Valkema, MD, PhD3; Eleni C. Vourvouri, MD, PhD1; Fabiola B. Sozzi, MD, PhD1; Jos R.T.C. Roelandt, MD, PhD1; and Don Poldermans, MD, PhD1 1Thoraxcenter, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands; 2Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; and 3Department of Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands Because of damage to cardiomyocytes and the contractile appa- In patients with ischemic cardiomyopathy, distinguishing ratus, contractile reserve may be observed less frequently in hi- between hibernating, stunned, and scarred myocardium may bernating than in stunned myocardium. The aim of this study was have important implications for clinical management and to assess the presence of contractile reserve in response to do- butamine infusion in a large group of patients with stunned and outcome. If hibernating or stunned myocardium is present, hibernating myocardium. Methods: A total of 198 consecutive coronary revascularization may not only reverse regional patients with ischemic cardiomyopathy (left ventricular ejection wall motion abnormalities but also improve global function, fraction Յ 40%) underwent resting 2-dimensional echocardiogra- heart failure symptoms, and survival (1–3). Hibernating phy to assess regional contractile dysfunction. On the basis of myocardium has been defined as a chronic state of contrac- assessment of perfusion (with 99mTc-tetrofosmin SPECT) and glu- tile dysfunction with reduced blood flow at rest (4,5). Fre- 18 cose use (with F-FDG SPECT), dysfunctional segments were quently, however, regional perfusion in chronic dysfunc- grouped.
    [Show full text]
  • Positron Emission Tomography and Myocardial Imaging
    Heart 2000;83:475–480 (generally a cyclotron).1 Production of isotopes IMAGING TECHNIQUES with the shortest half lives has to be carried out in the vicinity of the scanner and necessitates the installation of cyclotron and radiochemis- Positron emission tomography and try facilities. However, 18F compounds can be delivered from a relatively remote site of myocardial imaging production. The commercial success of PET has been driven by 18F labelled fluorodeoxyglu- 475 Paolo G Camici cose (FDG) which is used to measure glucose MRC Cyclotron Unit, Imperial College School of Medicine, metabolism in tissues. Because of the longer Hammersmith Hospital, London, UK half life of 18F (table 1), many centres rely on production from a centralised cyclotron, thus avoiding the expense of individual facilities. maging with positron emission tomography However, research centres aiming to derive (PET) oVers unrivalled sensitivity and spe- most from the power of PET require on site Icificity for research into biochemical path- production of a range of tracers. ways and pharmacological mechanisms in vivo. Cardiac and neurological research with PET Positron emission and detection has flourished over the past 20 years, but it is Positrons are emitted with a continuous range only more recently that cardiology has begun to of energies up to a maximum, which is charac- benefit from the advantages provided by PET. teristic of each particular isotope (table 1). The From the physical point of view, scanning of positron is successively slowed down by the heart presents a challenge because of Coulomb interaction with atomic electrons greater complications in correcting for photon and “annihilates” with an electron when its attenuation and scattered radiation, and be- energy has been reduced close to zero, resulting cause of movement of the heart and lungs.
    [Show full text]
  • Noninvasive Characterization of Stunned, Hibernating, Remodeled and Nonviable Myocardium in Ischemic Cardiomyopathy Jagat Narula, MD, PHD, FACC, Martin S
    Journal of the American College of Cardiology Vol. 36, No. 6, 2000 © 2000 by the American College of Cardiology ISSN 0735-1097/00/$20.00 Published by Elsevier Science Inc. PII S0735-1097(00)00959-1 Cardiomyopathy Noninvasive Characterization of Stunned, Hibernating, Remodeled and Nonviable Myocardium in Ischemic Cardiomyopathy Jagat Narula, MD, PHD, FACC, Martin S. Dawson, MD, Binoy K. Singh, MD, Aman Amanullah, MD, Elmo R. Acio, MD, Farooq A. Chaudhry, MD, FACC, Ramin B. Arani, PHD, Ami E. Iskandrian, MD, FACC Philadelphia, Pennsylvania OBJECTIVES We evaluated a novel protocol of dual-isotope, gated single-photon emission computed tomographic (SPECT) imaging combined with low and high dose dobutamine as a single test for the characterization of various types of altered myocardial dysfunction. BACKGROUND Myocardial perfusion tomography and echocardiography have been used separately for the assessment of myocardial viability. However, it is possible to assess perfusion, function and contractile reserve using gated SPECT imaging. METHODS We studied 54 patients with ischemic cardiomyopathy using rest and 4 h redistribution thallium-201 imaging and dobutamine technetium-99m sestamibi SPECT imaging. The sestamibi images were acquired 1 h after infusion of the maximal tolerated dose of dobutamine and again during infusion of dobutamine at a low dose to estimate contractile reserve. Myocardial segments were defined as hibernating, stunned, remodeled or scarred. RESULTS Severe regional dysfunction was present in 584 (54%) of 1,080 segments. Based on the combination of function and perfusion characteristics in these 584 segments, 24% (n ϭ 140) were labeled as hibernating; 23% (n ϭ 136) as stunned; 30% (n ϭ 177) as remodeled; and 22% (n ϭ 131) as scarred.
    [Show full text]
  • Amit R. Patel MD, FACC Associate Professor of Medicine and Radiology Director Cardiac MRI and CT
    Disclosures: Research support from Philips Research grant & Speaker’s Bureau Astellas Research grant from General Electric Research grant from Myocardial Solutions Off-label use of contrast agents Off-label use of adenosine/ regadenoson Utility of Cardiac MRI in Heart Failure Amit R. Patel MD, FACC Associate Professor of Medicine and Radiology Director Cardiac MRI and CT Cardiac Magnetic Resonance: A Multi-Parametric Evaluation Other Myocardial Processes Cine CMR Myocardial Myocardial Ischemia Scar (LGE) Myocardial Myocardial Fibrosis Capillary Leak (T1-W) Edema (T2-W) (T1-mapping) CMR and Heart Failure | 2 The Mother Holter Monitor • 33 year old woman with no significant past medical history. • Following birth of 2nd child, she developed CHF and palpitations. EKG Predominant Rhythm = NSR Occasional PVCs (2% of total QRS complexes) Frequent Bigeminy (noted particularly with symptomatic palpitations) Rare PACs(<1% of QRS complexes) 1 SVT Run (8 beats) No pauses No evidence for AV dissociation or block CMR and Heart Failure | 3 The Mother: Echocardiogram Clinical Diagnosis: Peripartum Cardiomyopathy CMR and Heart Failure | 4 The Mother: Cardiac Magnetic Resonance Genetic Testing: PKP2 (plakophylin 2) and Asn557Asp, likely Pathogenic. CMR and Heart Failure | 5 Final Diagnosis: Arrhythmogenic Right Ventricular Cardiomyopathy Arrhythmogenic Right Ventricular Cardiomyopathy • Inherited cardiomyopathy characterized by fibro-fatty replacement of the RV myocardium • Increased risk of ventricular tachycardia and right heart failure • Typically
    [Show full text]
  • Molecular Imaging in the Clinical Evaluation of Mitochondrial Function in Myocardium
    Proceedings of the World Medical Conference Molecular Imaging in the clinical evaluation of mitochondrial function in myocardium : The potential role of integrated Positron Emission Tomography Computed Tomography (PET/CT) in cardiac imaging Abdul Jalil Nordin, Wan Himratul Azliza Wan Harun, Ahmad Zaid Fatah Azman, Ahmad Fazli Abdul Aziz, Fathinul Fikri Ahmad Saad, Zul Hilmi Yaakob, Annuar Rapaie , Wan Azman Wan Ahmad Department of Diagnostic Imaging , Serdang Hospital, Abstract— Intact myocardial perfusion is a function of normal Malaysia upon approval by UPM Medical Ethic Committee. sodium potassium adenosine triphosphatase (ATPase) pump Thirty one patients diagnosed coronary artery disease were while normal myocardial viability is the function of intact prospectively recruited. Only 19 patients were finally enrolled mitochondrium. Both molecular processes can be clinically since insufficient data in the remaining 12 patients. All manipulated using non-invasive molecular imaging techniques. patients underwent pharmaceutical stress and rest myocardial Despite being a routine procedure, myocardial perfusion perfusion imaging (MPI) study using 99mTc-MIBI at Universiti imaging has inherent limitation in verifying viable myocardial Malaya Medical Centre, Kuala Lumpur upon diagnosis segments. Fluorodeoxyglucose (FDG), an analogue of glucose confirmation of ischaemic heart disease . The inclusion molecule is a gold standard biomarker in demonstrating criteria are clinical signs and symptoms of ischaemic heart viability. Integrating the two molecular processes in a clinical disease, raised cardiac enzymes, electrophysiological changes study will define and classify viable from non viable and evident from imaging modalities like cardiac scintigraphy myocardial segments. The function of viable myocardial using 99mTc-MIBI, echocardiography and Magnetic Resonance segments may benefit revascularization procedure while Imaging.
    [Show full text]
  • Cardiac F-18 FDG PET
    Cardiac F-18 FDG PET Table 3. Cardiac F-18 FDG PET Table 4. Elements of a comprehensive FDG report Parameter Recommendation Sections Information included Tracer dose (mCi) 5-10 (3D mode); Demographics • Patient demographics 10-15 (2D mode) • Study indications • Coronary anatomy if known Delay after injection (min) 45-60 (nondiabetics); and 2). Use of IV insulin (even in non-diabetic patients) is OVERVIEW 60-90 (diabetics) Methods • Technique and radiotracer dose for desirable whenever feasible in order to promote maximum perfusion and FDG imaging The purpose of this document is to specifically uptake of FDG by the normal myocardium and optimal Patient positioning Supine position • Stress test hemodynamic informa- identify the critical steps involved in perform- image quality. Following FDG injection, monitoring of the (arms up preferred) tion (when available) ing and interpreting a myocardial viability patient’s glucose levels should be continued until a stable Imaging mode 2D or 3D; list, gated or • Glucose loading technique study with F-18 labeled fluoro-deoxyglucose glucose level is ensured and the patient is asymptomatic. static (glucose load and insulin) (FDG) positron emission tomography (PET). Diabetic Patients: Diabetic patients have a limited ability This document will cover indications, patient Image duration (min) 10-30 (depends on count Findings: • Size, severity, and location of the to produce endogenous insulin and are less responsive to rate and dose) MPI and FDG stress (when available) and rest preparation, testing procedure, interpreta- insulin. For these reasons, standard glucose loading tech- perfusion defects tion, and reporting for FDG PET. niques may be less effective in such patients.
    [Show full text]
  • Acute Myocardial Infarction Complicated with Ventricular
    Acute Myocardial Infarction Complicated With Ventricular Tachycardia Infarto Agudo del Miocárdio complicado con taquicardia ventricular Infarto agudo do miocárdio complicado com taquicardia ventricular Where is located the “culprit” artery? ¿Donde está localizada la artéria culpada? Onde está a artéria culpada? Which is the diagnose of the sustained tachyarrhythmia? ¿ Cual es el diagnóstico de la taquiarritmia? Qual o diagnóstico da taquiarritmia? When polymorphic VT appears ST segment elevation degree decreases. Reperfusion Arrhythmia? Coronary angiography showed coronary oclusion + Stent primary angioplasty. Cuando la TV polimorfa aparece la elevación del segmento ST disminuye: ¿Arritmia de reperfusión? Coronariografia mostró oclusão con angioplastia primaria + Stent. Quando a TV polimórfica aparece a elevação do segmento ST diminui: Trata-se de arritmia de reperfusão? A coronariografia mostrou oclusão com angioplastia primária + stent Case from Dr Oscar Pellizón MD Argentine Caro Andrés: O infarto é de localização ântero-lateral e a artéria culpada, provalmente é a DA. A taquicardia ventricular pode representar neste caso, arritmia de reperfusão. Sabemos que as arritmias de reperfusão se manifestam, em se tratando de taqui-arritmias, seja como TVNS, TV-Sustrentada, ritmo idioventricular acelerado ,torsades de pointe e fibrilação ventricular, seja por reperfusão espontânea, seja determinada por angioplastia coronária Um grande abraço do amigo Hélio Germiniani. Dear Andrés: The myocardial infarction is located in anterolateral wall, and the culprit artery, is probably the left anterior descending artery (LAD). Ventricular tachycardia can represent in this case a reperfusion arrhythmia. We know that reperfusion arrhythmias manifest in the case of tachyarrhythmias as non-sustained ventricular tachycardia (NS-VT), sustained ventricular tachycardia(S-VT), accelerated idioventricular rhythm, torsades de pointes and ventricular fibrillation, either by spontaneous reperfusion, or determined by coronary angioplasty A big hug from friend Professor Dr.
    [Show full text]
  • Is There an Association Between Hibernating Myocardium and Left Ventricular Mechanical Dyssynchrony in Patients with Myocardial Infarction?
    Original Article Is there an association between hibernating myocardium and left ventricular mechanical dyssynchrony in patients with myocardial infarction? Abstract Objective: Left ventricular mechanical dyssynchrony (LVMD) is an important factor in the prognosis of pati- Feifei Zhang1 MD, 1 ents with myocardial infarction (MI). The aim of this study was to identify the correlation between LVMD and Wei Yang MD, hibernating myocardium in MI patients by radionuclide myocardial imaging. Subjects and Methods: This Yuetao Wang1 MD, 2 study consisted of 91 patients who had a history of denite prior MI and underwent both technetium-99m Haipeng Tang MS, 99m 1 methoxyisobutylisonitrile ( Tc-MIBI) gated single photon emission tomography (SPET) myocardial perfu- Jianfeng Wang MD, sion imaging (MPI) and uorine-18 uorodeoxyglucose (18F-FDG) positron emission tomography (PET) my- Xiaoliang Shao1 MD， ocardial metabolic imaging. Left ventricular (LV) functional and LVMD parameters were measured from ga- Ziyi Wang3 BS, ted SPET MPI, while myocardial viability was assessed by the integral quantitative analysis of SPET MPI and 18 Xiaoying Zhang4 MD, F-FDG PET. Left ventricular MD was dened as >mean+2SD of phase bandwidth (PBW) in the control gro- Ling Yang5 PhD, up. Results: Left ventricular MD was present in 37/91 (40.7%) MI patients. The extent of hibernating myo- Xiaosong Wang1 MD, cardium (SPET/PET mismatch) and scar (SPET/PET match) in patients with LVMD was signicantly higher Weihua Zhou2 PhD than in patients without LVMD (15.24±11.26% vs 4.89±5.41%, P<0.001; 11.11±9.42% vs 4.72±5.71%, P< 0.001; respectively).
    [Show full text]
  • Myocyte Degeneration and Cell Death in Hibernating Human Myocardium
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector JACC Vol. 27, No. ‘7 June 19964577-85 1577 MYOCARDIAL ISCHEMA Myocyte Degeneration and Cell Death in Hibernating Human Myucardium ERNST R. SCHWARZ, MD, JUTTA SCHAFER, MD,* JUERGEN VOM DAHL, MD, CARSTEN ALTEHOEFER, MD, BEATE GPOHMANN, TA,* FRiEDRICH SCHOENDUBE, MD, MS, FLORENCE H. SHEEHAN, MD.t RAINER UEBIS, MD, UDALRICH BUELL, MD, BRUNO J. MESSMER, MD, FACC, WOLFGANG SCHAPER, MD,* PETER HANRATH, MD, FACC Aachen am-l Bad Nauheim, Germany; and Seattk, Washington - --. O&etives. Tbe aim of this study wns to analyze the morpho- logic characteristics of myocyte degeneration ieadiag to replete- etai proteins titia a& aipita-actinin. Eiectroi microsc&of the q eot ftbrosis in hibernating myocardium by use of electron ceil organeiies and immunoldetochemlral aaaiysis of the eytasimi- microscopy and immunobistochemkai tecimiques. etonsbowedasimilarityintbedegweofd aiteNuone. Baekgtwmd. Data on tbe uitrastructure aad the cytoskeieton of Group 1(0 = 11) replusellted patients with ouiy aliuor atrucwai dterations, whereas group 2 (II = W) showed severe morpitkgk or deiayed tkmctionai recovery might be due to a variable degree of degeuerative cboges. Wall motion abnormalities shrewd pastup cardiomyoeyte degeneration in hiberaating mywardium. emtive improv~ets, and msdaar imaghg mealed a per&&m Me&oak In 24 patients, regionai waii motion abaonuaiities metabolism mismatch wit&out signllkmt di&- between the were analyzed by use of the cwtteriine method before and 6 f 1 PUPS. months after coronary artery bypass surgery. Preoperative tecimetium-9Pm sestamibi uptake was measured by singi~photoa emission computed tomograpay for assessing regjonat perfkufion.
    [Show full text]
  • Stunned Myocardium Due to Decompensation from Hypovolemic Shock in a Pregnant Woman with Uterine Atony Following Cesarean Sectio
    & Experim l e ca n i t in a l l C C f a Journal of Clinical & Experimental o r d l i a o n l o r g u Lee, et al., J Clin Exp Cardiolog 2016, 7:5 y o J Cardiology ISSN: 2155-9880 DOI: 10.4172/2155-9880.1000448 Case Report Open Access Stunned Myocardium due to Decompensation from Hypovolemic Shock in a Pregnant Woman with Uterine Atony Following Cesarean Section Lee HS1*, Hans C1, Visco F2, Mushiyev S2 and Pekler G2 1Department of Medicine, Metropolitan Hospital, New York Medical College, New York, USA 2Division of Cardiology, Department of Medicine, Metropolitan Hospital, New York Medical College, New York, USA *Corresponding author: Lee HS, Department of Medicine, Metropolitan Hospital, New York Medical College, New York, USA, Tel: 212 423 8456; Fax: 212 423 6338; E- mail: [email protected] Received date: April 05, 2016; Accepted date: May 30, 2016; Published date: May 31, 2016 Copyright: © 2016 Lee HS, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Transient post ischemic left ventricular dysfunction has been called stunned myocardium. The stunned myocardium can lead cardiac problems such as arrhythmias, left ventricular dysfunction, and a myocardial infarction. Stunned myocardium is a reversible condition. In this case, a 25 year old female patient with a history of mild intermittent asthma became hypovolemic and got into shock after developing uterine atony following a cesarean section.
    [Show full text]
  • Retrospective Fatal Event Due to Simultaneous Multivessel Coronary Spasm Stefan Peters
    ORIGINAL ARTICLE Back to the Roots: Retrospective Fatal Event Due to Simultaneous Multivessel Coronary Spasm Stefan Peters Department of Cardiology, Harzklinikum Dorothea Christiane Erxleben GmbH, Quedlinburg, Germany ABSTRACT Introduction: Hibernating myocardium due to multivessel coronary spasm was first described in 1991. Methods and Results: In 1997, we saw the female patient after hysterectomy with profound hypotension in the cath lab. An ischemic event was suggested, the electrocardiography revealed ST elevation in all leads. A multivessel coronary spasm was found, after initial solution of spasm with i.a. verapamil, no coronary lesions were seen. Conclusion: Retrospectively, this was one the first reports with fatal event. As in the follow-up, the multivessel spasm could not be constantly solved the patient died. Key words: Hibernating myocardium, multivessel coronary spasm, takotsubo syndrome, verapamil INTRODUCTION administration of verapamil at a dosage of 6.25 ml in both ostia, coronary angiography could be done without any ibernating myocardium due to simultaneous lesions. Paradoxically, blood pressure after verapamil multivessel coronary spasm was first described by infusion was 80/60 mm of mercury. The examination was Dote et al.[1] in 1991. Not until 2000 and 2001, the finished and the patient went to the intensive care unit. Four H hours later, the patient died of acute development of recurrent term “takotsubo cardiomyopathy” was initiated describing left ventricular appearance with apical ballooning with non- hypotension. obstructed coronary arteries. DISCUSSION METHODS AND RESULTS Prolonged, post-ischemic left ventricular dysfunction due Retrospectively, in 1997, we saw a female patient 68 years to spasm,[1] myocardial bridging,[2] recurrent segment of of age directly from the surgical theatre in the cath lab of the the left anterior descending coronary artery,[3] and transient hospital of Quedlinburg, Germany.
    [Show full text]
  • Hibernation and Heart Failure P G Camici
    141 MINI-SYMPOSIUM Heart: first published as 10.1136/hrt.2003.016626 on 16 January 2004. Downloaded from Hibernation and heart failure P G Camici ............................................................................................................................... Heart 2004;90:141–143. doi: 10.1136/hrt.2003.023119 eart failure accounts for approximately 20% of all in the infarcted and hibernating segments. The changes in hospital admissions among people over 65, and in the ventricular geometry, local wall strain, and filling pres- past 10 years the hospitalisation rate has increased by sures combine to increase the metabolic requirements of H 1 almost 160%. Although different large randomised trials such myocardium which, while ‘‘remote’’ from the site of carried out during the past two decades have demonstrated a infarction, adopts a ‘‘crucial’’ role in maintaining cardiac significant reduction in mortality for heart failure patients output. These segments undergo compensatory hypertro- treated medically, symptomatic heart failure continues to phy, but in the long term adverse ‘‘remodelling’’ and have a one year mortality close to 45%.23 ventricular dilatation occurs leading to heart failure.1 In an effort to improve the early recognition of heart failure, the American College of Cardiology and the American Based on available studies, it is logical to assume that the Heart Association have recently proposed a new approach to beneficial effect of coronary revascularisation in heart fail- the classification of heart failure based on four progressive ure derives primarily from recovery of contractile function stages.4 This new categorisation emphasises the evolution in hibernating segments which, in turn, may attenuate 8 and progression of heart failure and is quite different from remodelling.
    [Show full text]