Imaging and Diagnostic TestingAssessment of residual myocardial viability in regions with chronic electrocardiographic Q-wave infarction☆,☆☆
Section snippets
Patient population, study protocol
The study included 150 consecutive patients with chronic electrocardiographic Q-wave infarction, heart failure symptoms, and chronic coronary artery disease. Initially, 195 patients were considered for inclusion; however, patients with electrocardiographic evidence of intraventricular conduction abnormalities (5 patients with left bundle branch block, 8 with right bundle branch block), primary cardiomyopathy (n = 4), significant valvular heart disease (n = 17), or an unacceptable acoustic
Patient population, electrocardiographic results
All patients had heart failure symptoms; New York Heart Association (NYHA) functional class was on average 2.8 ± 0.7, whereas 72% of the patients were in NYHA functional class III or IV. The left ventricular function was severely impaired in all patients; ejection fraction averaged 31% ± 12%. Importantly, 40 (27%) patients had left ventricular ejection fraction <25%. The clinical characteristics of the study population are presented in Table I.
Discussion
The findings in the current study demonstrate that chronic Q waves on the electrocardiogram do not exclude the presence of viable myocardial tissue in patients with severely depressed left ventricular function. An EDWT ≤6 mm, indicating scar tissue, was more frequently observed in Q-wave regions than in dysfunctional regions without Q waves. In general, regions with an EDWT ≤6 mm were scarce. Only 19 of 517 regions had an EDWT ≤6 mm. La Canna et al12 comparably showed that only 13% of
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Cited by (47)
State-of-the-Art Quantitative Assessment of Myocardial Ischemia by Stress Perfusion Cardiac Magnetic Resonance
2019, Magnetic Resonance Imaging Clinics of North AmericaCitation Excerpt :Likewise, Hundley and colleagues,70 using dobutamine in 163 patients with unfavorable echocardiographic windows, demonstrated sensitivity and specificity of 83% in the detection of coronary stenosis greater than 50% per coronary angiography. Various studies of CMR using dobutamine to induce of ischemia suggest that the presence of segmental contractile dysfunction in only 1 segment (6% of ischemic load) is already a predictor of worse outcome.71,72 Any difference between the number of segments with reduced perfusion and the number of segments with wall motion abnormalities could be explained by the sequence of events in the ischemic cascade.
2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: Implant and follow-up recommendations and management
2012, Heart RhythmCitation Excerpt :Identification of confluent regions of scar that could influence LV lead placement can be identified and analysed with CMR imaging techniques that include late gadolinium enhancement and delayed contraction assessed with tagged imaging.28–30 Echocardiography is usually non-diagnostic in determining scar or location even though the presence of end-diastolic myocardial thickness <6 mm is highly suggestive of transmural scar.31 Finally, the definitive determination of viability achieved whether by CMR or dobutamine-stress echocardiography may be imperative to a successful outcome.32
Three-dimensional echocardiography for the preoperative assessment of patients with left ventricular aneurysm
2011, Annals of Thoracic SurgeryCitation Excerpt :The traced contours were then used to calculate LV regional thickness according to the standard 16-segment model (Fig 2) [10]. In particular, as previously described [12], severely thinned regions (end-diastolic thickness <6 mm) were considered to be representative for transmural scar. To evaluate the severity of mitral regurgitation, the effective regurgitant orifice area (EROA) was calculated [13–15].
Myocardial Viability: Comparison with Other Techniques. Comparison with Other Techniques.
2010, Clinical Nuclear Cardiology: State of the Art and Future DirectionsMyocardial viability: Comparison with other techniques
2010, Clinical Nuclear CardiologyRole of echocardiography in the assessment of myocardial viability
2009, American Journal of the Medical SciencesCitation Excerpt :Cwajg et al33 found similarly high sensitivity for end-diastolic wall thickness >6 mm for prediction of contractile function recovery after revascularization (sensitivity 94%, specificity 48%). Finally, Schinkel et al34 showed that myocardial segments with LV end-diastolic wall thickness <6 mm very rarely have contractile reserve. Based on these studies, LV end-diastolic wall thickness <5 to 6 mm virtually excludes the possibility of contractile recovery after revascularization.
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Reprint requests: Don Poldermans, MD, PhD, Thoraxcenter Room Ba 300, Department of Cardiology, Erasmus Medical Center, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
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E-mail: [email protected]