The histology of viable and hibernating myocardium in relation to imaging characteristics.

Abstract:

OBJECTIVES:This study characterizes the histology of myocardium predicted to be hibernating using three different imaging techniques to explain the discordance among them. BACKGROUND:Both radionuclide and functional imaging techniques were used to assess myocardial hibernation. The former have high sensitivity and the latter high specificity for predicting functional recovery. METHODS:Nineteen patients underwent thallium-201 and 99m-technetium tetrofosmin myocardial perfusion imaging, and dobutamine magnetic resonance imaging (MRI), prior to coronary bypass grafting. Criteria for predicted hibernation for each technique were defined before operation. Postoperative criteria for scar and true hibernation were also defined. Biopsies were analyzed for myocyte volume fraction (MVF), glycogen deposition and pathologic cell features. RESULTS:Thallium was most sensitive in predicting hibernation (88%) and MRI most specific (84%); and, although there was good agreement between thallium and tetrofosmin (85%), agreement between MRI and thallium (59%) or tetrofosmin (59%) was poor. For each technique, MVF was higher in segments predicted to be hibernating rather than scar (p < 0.05). The MVF was higher where both thallium and MRI predicted hibernation (0.77+/-0.07) than in segments predicted by thallium alone (0.69+/-0.13, p < 0.05). Proven hibernating segments had a higher MVF than scar (0.72+/-0.11 vs. 0.6+/-0.26, p < 0.05). CONCLUSIONS:Preservation of myocyte fraction is an important determinant of functional recovery after revascularization. A higher myocyte fraction is required to maintain contractile reserve than to achieve significant tracer uptake. This explains the higher sensitivity of radionuclide imaging compared with dobutamine MRI in the identification of myocardial hibernation.

journal_name

J Am Coll Cardiol

authors

Gunning MG,Kaprielian RR,Pepper J,Pennell DJ,Sheppard MN,Severs NJ,Fox KM,Underwood SR

doi

10.1016/s0735-1097(01)01766-1

subject

Has Abstract

pub_date

2002-02-06 00:00:00

pages

428-35

issue

3

eissn

0735-1097

issn

1558-3597

pii

S0735109701017661

journal_volume

39

pub_type

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