Intra-procedural determination of viability by myocardial deformation imaging: a randomized prospective study in the cardiac catheter laboratory.
Clin Res Cardiol
; 106(8): 629-644, 2017 Aug.
Article
em En
| MEDLINE
| ID: mdl-28321497
ABSTRACT
BACKGROUND:
The benefit of revascularization for functional recovery depends on the presence of viable myocardial tissue.OBJECTIVE:
Myocardial deformation imaging allows determination of myocardial viability.METHODS:
In a first approach, we assessed the optimal cutoff value to determine preserved viability by layer-specific echocardiographic myocardial deformation imaging at rest and low-dose dobutamine (DSE) echocardiography regional endocardial circumferential strain (eCS) <-19% at rest was as accurate as eCS at DSE. In a main study, 123 patients (66% men, age 59 ± 6 years) with relevant coronary stenoses and corresponding severe regional myocardial dysfunction were included and randomized in 2 groups after coronary angiography group A intra-procedural myocardial deformation imaging in the cardiac catheter laboratory (CLab), determination of myocardial viability by regional eCS <-19%, in case of positive viability immediate coronary intervention in the same session. Group B two-step determination of myocardial viability by cardiovascular magnetic resonance (CMR), in case of positive viability coronary intervention. After 18 months follow-up an analysis of the endpoints regarding cardiovascular events, left ventricular (LV) function, and comparison of cost was performed.RESULTS:
Group A (N = 61) and group B (N = 62) showed no differences concerning localization of the coronary stenosis, comorbidities, or medical therapy. Cardiovascular events at 18-month follow-up were as follows group A 13% (N = 10) vs. group B 14% (N = 9, p = 0.288); improvement of LV function group A +7 ± 2% vs. group B +7 ± 3%, p = 0.963; costs group A 3096 Dollar vs. group B 6043 Dollar, p < 0.001.CONCLUSION:
Intra-procedural determination of myocardial viability by myocardial deformation imaging in the CLab is feasible, safe, and cost effective and may become an emerging alternative to the current practice of two-stage viability diagnostics.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Cateterismo Cardíaco
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Função Ventricular Esquerda
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Angiografia Coronária
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Imagem Cinética por Ressonância Magnética
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Ecocardiografia sob Estresse
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Infarto do Miocárdio
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Revascularização Miocárdica
Tipo de estudo:
Clinical_trials
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Diagnostic_studies
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Observational_studies
Limite:
Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article