HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Norbert Augustin Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Haas, F. Articles by Lange, R. Search for Related Content PubMed PubMed Citation Articles by Haas, F. Articles by Lange, R. Related Collections Cardiac - physiology Coronary disease

Eur J Cardiothorac Surg 2001;20:290-298
© 2001 Elsevier Science NL

Ischemically compromised myocardium displays different time-courses of functional recovery: correlation with morphological alterations?

^a Department of Cardiovascular Surgery, Deutsches Herzzentrum Muenchen, Munich, Germany
^b Department of Pathology, GSF Muenchen, Technische Universitaet Muenchen, Munich, Germany
^c Department of Nuclear Medicine, Technische Universitaet Muenchen, Munich, Germany

Received 18 October 2000; received in revised form 4 April 2001; accepted 27 April 2001.

Corresponding author. Tel.: +49-89-1218-4111; fax: +49-89-1218-4113
e-mail: haas{at}dhm.mhn.de

Objective: It has been demonstrated that positron emission tomography (PET) predicts the functional recovery of viable but ischemically compromised myocardium. Reversible contractile dysfunction after revascularization has been reported for ‘hibernating myocardium’ and stunned myocardium, however, there are little data concerning the time-course and the extent of improvement of the two different pathophysiological conditions. Methods: Twenty-nine patients with advanced coronary artery disease and severely reduced left ventricular function (EF 18–35%) who were referred for isolated coronary artery bypass grafting underwent preoperative PET viability assessment and were functionally assessed by two-dimensional echocardiography preoperatively at 11 days, 14 weeks, and more than 12 months after surgical revascularization. Intraoperative biopsies were taken from dysfunctional areas defined by PET as segments of normal perfusion and normal metabolism (stunned myocardium) and from areas with a ‘mismatch’ between perfusion and metabolism (hibernating myocardium). The degree of morphological alterations was evaluated by electron microscopy. Results: In 70% of the 240 dysfunctional segments, ‘stunned myocardium’ was present whereas ‘hibernating myocardium’ could be detected in only 24% (P<0.01). Hibernating myocardium was associated with more severe preoperative wall motion abnormalities and incomplete postoperative recovery. After 1 year, 31% of ‘stunned’ segments vs. only 18% of ‘hibernating’ segments showed complete functional restoration (P<0.05). This incomplete improvement was associated with more severe morphological alterations including depletion of sarcomeres, accumulation of glycogen, loss of sarcoplasmatic reticulum, and cellular sequestration. Conclusions: These data indicate that in patients with severe ischemic left ventricular dysfunction ‘stunned myocardium’ is more prevalent than ‘hibernation’. Functional normalization is more frequent in ‘stunned’ segments, whereas areas of ‘hibernation’ showed more severe tissue injury and protracted recovery. Different degrees of myocardial injury coexist in most patients, which determines the time-course and the extent of improvement after revascularization.

Key Words: Severe left ventricular dysfunction • Myocardial viability • Positron emission tomography • Functional improvement • Morphological alterations • Electron microscopy

This article has been cited by other articles:

				C. Y. Kim, H. Y. Hwang, J. C. Paeng, D. S. Lee, and K.-B. Kim Improved myocardial perfusion and thickening after off-pump revascularization: 5-year follow-up. Ann. Thorac. Surg., November 1, 2009; 88(5): 1419 - 1425. [Abstract] [Full Text] [PDF]

				O. Bondarenko, A. M. Beek, J. W.R. Twisk, C. A. Visser, and A. C. van Rossum Time course of functional recovery after revascularization of hibernating myocardium: a contrast-enhanced cardiovascular magnetic resonance study Eur. Heart J., August 2, 2008; 29(16): 2000 - 2005. [Abstract] [Full Text] [PDF]

				A. Angelini, G. Maiolino, G. La Canna, C. Ceconi, F. Calabrese, E. Pettenazzo, M. Valente, O. Alfieri, G. Thiene, and R. Ferrari Relevance of apoptosis in influencing recovery of hibernating myocardium Eur J Heart Fail, April 1, 2007; 9(4): 377 - 383. [Abstract] [Full Text] [PDF]

				K. R. Cho, H. Y. Hwang, W. J. Kang, D. S. Lee, and K.-B. Kim Progressive improvement of myocardial perfusion after off-pump revascularization with bilateral internal thoracic arteries: Comparison of early versus 1-year postoperative myocardial single photon emission computed tomography J. Thorac. Cardiovasc. Surg., January 1, 2007; 133(1): 52 - 57. [Abstract] [Full Text] [PDF]

				R. S. Ronson, J. D. Puskas, V. H. Thourani, D. A. Velez, B. L. Bufkin, J. Glass, R. A. Guyton, and J. Vinten-Johansen Controlled intermittent asystole cardiac therapy induced by pharmacologically potentiated vagus nerve stimulation in normal and hibernating myocardium Ann. Thorac. Surg., June 1, 2003; 75(6): 1929 - 1936. [Abstract] [Full Text] [PDF]

				R. S. B. Beanlands, T. D. Ruddy, R. A. deKemp, R. M. Iwanochko, G. Coates, M. Freeman, C. Nahmias, P. Hendry, R. J. Burns, A. Lamy, et al. Positron emission tomography and recovery following revascularization (PARR-1): the importance of scar and the development of a prediction rule for the degree of recovery of left ventricular function J. Am. Coll. Cardiol., November 20, 2002; 40(10): 1735 - 1743. [Abstract] [Full Text] [PDF]