Residual coronary reserve identifies segmental viability in patients with wall motion abnormalities

Paolo Marzullo, Oberdan Parodi, Gianmario Sambuceti, Assuero Giorgetti, Eugenio Picano, Alessia Gimelli, Piero Salvadori, Antonio L'Abbate

Research output: Contribution to journalArticle

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Abstract

Objectives. The aim of this study was to determine whether the presence of residual coronary reserve can in itself identify viable segments. Background. Experimental data suggest that despite hypoperfusion at rest, viable myocardium may exhibit persistence of coronary reserve. Preliminary observations in patients show that in basally dyssynergic areas, a residual vasodilator capability is present despite hypoperfusion at rest and that a flow-mediated increase in regional wall motion identifies residual viability. Methods. Fourteen patients with evidence of previous myocardial infarction, infarct-related single-vessel coronary artery disease and impaired regional ventricular function at rest underwent positron emission viability imaging by fluorine-18 deoxyglucose. In addition, blood flow at rest and vasodilator capability were regionally evaluated in all patients by means of nitrogen-13 ammonia. Results. Of a total of 252 segments, 133 were dyssynergic at rest. Of these 133 segments, 60 (group 1) showed normal metabolic activity and only mild reduction in myocardial blood flow. The other 73 segments showed a marked reduction in flow; of these, 25 (group 2, viable) had persistent metabolic activity, whereas 48 (group 3, necrotic) did not. Despite similar levels of hypoperfusion at rest, group 2 segments showed a preserved coronary reserve that was virtually absent in necrotic segments (2.6 ± 1.3 vs. 1.3 ± 0.5, p <0.01). This value was similar to that observed in viable group 1 segments (2.5 ± 1.6, p = NS). Conclusions. In addition to characterizing myocardium at risk, imaging of coronary flow at baseline and after dipyridamole by positron emission tomography provides helpful information on myocardial viability that may integrate the "static" viability information obtained with the baseline flow/metabolic approach.

Original languageEnglish
Pages (from-to)342-350
Number of pages9
JournalJournal of the American College of Cardiology
Volume26
Issue number2
DOIs
Publication statusPublished - 1995

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Vasodilator Agents
Myocardium
Myocardial Infarction
Ventricular Function
Dipyridamole
Fluorine
Deoxyglucose
Ammonia
Positron-Emission Tomography
Coronary Artery Disease
Nitrogen
Electrons

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Nursing(all)

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Residual coronary reserve identifies segmental viability in patients with wall motion abnormalities. / Marzullo, Paolo; Parodi, Oberdan; Sambuceti, Gianmario; Giorgetti, Assuero; Picano, Eugenio; Gimelli, Alessia; Salvadori, Piero; L'Abbate, Antonio.

In: Journal of the American College of Cardiology, Vol. 26, No. 2, 1995, p. 342-350.

Research output: Contribution to journalArticle

Marzullo, Paolo ; Parodi, Oberdan ; Sambuceti, Gianmario ; Giorgetti, Assuero ; Picano, Eugenio ; Gimelli, Alessia ; Salvadori, Piero ; L'Abbate, Antonio. / Residual coronary reserve identifies segmental viability in patients with wall motion abnormalities. In: Journal of the American College of Cardiology. 1995 ; Vol. 26, No. 2. pp. 342-350.
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T1 - Residual coronary reserve identifies segmental viability in patients with wall motion abnormalities

AU - Marzullo, Paolo

AU - Parodi, Oberdan

AU - Sambuceti, Gianmario

AU - Giorgetti, Assuero

AU - Picano, Eugenio

AU - Gimelli, Alessia

AU - Salvadori, Piero

AU - L'Abbate, Antonio

PY - 1995

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N2 - Objectives. The aim of this study was to determine whether the presence of residual coronary reserve can in itself identify viable segments. Background. Experimental data suggest that despite hypoperfusion at rest, viable myocardium may exhibit persistence of coronary reserve. Preliminary observations in patients show that in basally dyssynergic areas, a residual vasodilator capability is present despite hypoperfusion at rest and that a flow-mediated increase in regional wall motion identifies residual viability. Methods. Fourteen patients with evidence of previous myocardial infarction, infarct-related single-vessel coronary artery disease and impaired regional ventricular function at rest underwent positron emission viability imaging by fluorine-18 deoxyglucose. In addition, blood flow at rest and vasodilator capability were regionally evaluated in all patients by means of nitrogen-13 ammonia. Results. Of a total of 252 segments, 133 were dyssynergic at rest. Of these 133 segments, 60 (group 1) showed normal metabolic activity and only mild reduction in myocardial blood flow. The other 73 segments showed a marked reduction in flow; of these, 25 (group 2, viable) had persistent metabolic activity, whereas 48 (group 3, necrotic) did not. Despite similar levels of hypoperfusion at rest, group 2 segments showed a preserved coronary reserve that was virtually absent in necrotic segments (2.6 ± 1.3 vs. 1.3 ± 0.5, p <0.01). This value was similar to that observed in viable group 1 segments (2.5 ± 1.6, p = NS). Conclusions. In addition to characterizing myocardium at risk, imaging of coronary flow at baseline and after dipyridamole by positron emission tomography provides helpful information on myocardial viability that may integrate the "static" viability information obtained with the baseline flow/metabolic approach.

AB - Objectives. The aim of this study was to determine whether the presence of residual coronary reserve can in itself identify viable segments. Background. Experimental data suggest that despite hypoperfusion at rest, viable myocardium may exhibit persistence of coronary reserve. Preliminary observations in patients show that in basally dyssynergic areas, a residual vasodilator capability is present despite hypoperfusion at rest and that a flow-mediated increase in regional wall motion identifies residual viability. Methods. Fourteen patients with evidence of previous myocardial infarction, infarct-related single-vessel coronary artery disease and impaired regional ventricular function at rest underwent positron emission viability imaging by fluorine-18 deoxyglucose. In addition, blood flow at rest and vasodilator capability were regionally evaluated in all patients by means of nitrogen-13 ammonia. Results. Of a total of 252 segments, 133 were dyssynergic at rest. Of these 133 segments, 60 (group 1) showed normal metabolic activity and only mild reduction in myocardial blood flow. The other 73 segments showed a marked reduction in flow; of these, 25 (group 2, viable) had persistent metabolic activity, whereas 48 (group 3, necrotic) did not. Despite similar levels of hypoperfusion at rest, group 2 segments showed a preserved coronary reserve that was virtually absent in necrotic segments (2.6 ± 1.3 vs. 1.3 ± 0.5, p <0.01). This value was similar to that observed in viable group 1 segments (2.5 ± 1.6, p = NS). Conclusions. In addition to characterizing myocardium at risk, imaging of coronary flow at baseline and after dipyridamole by positron emission tomography provides helpful information on myocardial viability that may integrate the "static" viability information obtained with the baseline flow/metabolic approach.

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