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. 2006 Oct 27;7(4):349–356. doi: 10.1111/j.1542-474X.2002.tb00184.x

Directct Epicardial Mapping Can Differentiate Hibernating from Scarred Myocardium: A Validation Study with 18F‐FDG‐PET

Christian Vahlhaus 1,✉, Michael Schäfers 2, Hans‐Jürgen Bruns 1, Frauke Janssen 1, Jorg Stypmann 1, Dieter Hammel 3, Hans H Scheld 3, Otmar Schober 2, Günter Breithardt 1, Thomas Wichter 1
PMCID: PMC7027679  PMID: 12431313

Abstract

Aim: This study investigated the value of epicardial mapping immediately before CABG in the differentiation of hibernating from scarred myocardium in correlation to the noninvasive gold standard 18F‐FDG PET.

Methods and Results: In 35 patients with CAD, myocardial perfusion (99mTc‐Tetrofosmin‐SPECT), viability (18F‐FDG‐PET), and function (LVangiography) were assessed before CABG. 102 bipolar epicardial electrograms per patient (n = 3570 electrograms) were recorded simultaneously with a ventricular jacket array. Based on the scintigraphic and LV angiographic data at the site of each electrode with good myocardial contact (n = 1963), segments (n = 492, 14.1 ± 5.6 per patient; mean ± SD) were classified into three groups: hibernating (n = 139), scarred (n = 104), and control (n = 249). Regional mean bipolar voltage values were calculated for Receiver Operating Characteristic (ROC) analysis. Mean bipolar voltage was significantly lower in scarred when compared to hibernating myocardium. ROC curve analysis (area under the curve of O.92 ± 0.47, mean ± SE) for mean bipolar voltage to discriminate between hibernating and scarred myocardium revealed a sensitivity of 94% with a specificity of 83% at a cut‐off value of 8.75 mV.

Conclusion: Hibernating myocardium can be differentiated correctly from scarred myocardium by direct epicardial mapping. In the future, hibernating myocardium may be detectable by body surface mapping techniques using inverse solutions. A.N.E. 2002;7(4):349–356

Keywords: hibernating myocardium, mapping

REFERENCES

  • 1. Heusch G, Schulz R. Hibernating myocardium: A review. J Mol Cell Cardiol 1996;28:2359–2372. [DOI] [PubMed] [Google Scholar]
  • 2. Fuchs S, Kornowski R, Shiran A, et al. Electromechanical characterization of myocardial hibernation in a pig model. Coron Artery Dis 1999;10: 195–198. [DOI] [PubMed] [Google Scholar]
  • 3. Callans DJ, Ren JF, Michele J, et al. Electroanatomic left ventricular mapping in the porcine model of healed anterior myocardial infarction: Correlation with intracardiac echo‐cardiography and pathological analysis. Circulation 1999;100:1744–1750. [DOI] [PubMed] [Google Scholar]
  • 4. Bolli R, Zhu WX, Thornby JI, et al. Time course and determinants of recovery of function after reversible ischemia in conscious dogs. Am J Physiol 1988;254:H102–H114. [DOI] [PubMed] [Google Scholar]
  • 5. Knuuti MJ, Nuutila P, Ruotsalainen U, et al., Euglycemic hyperinsulinemic clamp and oral glucose load in stimulating myocardial glucose utilization during positron emission tomography. J Nucl Med 1992;33: 1255–1262. [PubMed] [Google Scholar]
  • 6. DeFronzo RA, Tobin JD, Andres R. Glucose clamp technique: A method for quantifying insulin secretion and resistance. Am J Physiol 1979;237:E214–E223. [DOI] [PubMed] [Google Scholar]
  • 7. Gambhir SS, Schwaiger M, Huang SC, et al. Simple nonin‐vasive quantification method for measuring myocardial glucose utilization in humans employing positron emission tomography and fluorine‐18 deoxyglucose. J Nucl Med 1989;30:359–366. [PubMed] [Google Scholar]
  • 8. Patlak CS, Blasberg RG. Graphical evaluation of blood‐to‐brain transfer constants from multiple‐ time uptake data. Generalizations. J Cereb Blood Flow Metab 1985;5: 584–590. [DOI] [PubMed] [Google Scholar]
  • 9. Biedenstein S, Schafers M, Stegger L, et al. Three‐dimensional contour detection of left ventricular myocardium using elastic surfaces. Eur J Nucl Med 1999;26:201–207. [DOI] [PubMed] [Google Scholar]
  • 10. Stegger L, Biedenstein S, Schafers KP, et al. Elastic surface contour detection for the measurement of ejection fraction in myocardial perfusion SPET. Eur J Nucl Med 2001;28:48–55. [DOI] [PubMed] [Google Scholar]
  • 11. Bruns HJ, Janssen F, Schäfers M, et al. Signal characteristics of multichannel epicardial electrograms in chronic isch‐emic and scarred myocardium: Electromechanical mismatch indicates viability in regions of myocardial dysfunction. Basic Res Cardiol 2001;96:98–105. [DOI] [PubMed] [Google Scholar]
  • 12. Heyndrickx GR, Millard RW, McRitchie RJ, et al. Regional myocardial functional and electrophysiological alterations after brief coronary artery occlusion in conscious dogs. J Clin Invest 1975;56: 978–985. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13. Walton S. Radionuclide techniques for myocardial viability and hibernation. Heart 1999;81:6–7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14. Narula J, Dawson MS, Singh BK, et al. Noninvasive characterization of stunned, hibernating, remodeled and nonviable myocardium in ischemic cardiomyopathy. J Am Coll Cardiol 2000;36:1913–1919. [DOI] [PubMed] [Google Scholar]
  • 15. Cigarroa CG, DeFilippi CR, Brickner ME, et al. Dobutamine stress echocardiography identifies hibernating myocardium and predicts recovery of left ventricular function after coronary revascularization. Circulation 1993;88:430–436. [DOI] [PubMed] [Google Scholar]
  • 16. Kim RJ, Wu E, Rafael A, et al. The use of contrast‐enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med 2000;343:1445–1453. [DOI] [PubMed] [Google Scholar]
  • 17. Perrone‐Filardi P, Pace L, Prastaro M, et al. Assessment of myocardial viability in patients with chronic coronary artery disease: Rest‐4‐hour‐24‐hour 201T1 tomography versus dobutamine echocardiography. Circulation 1996;94: 2712–2719. [DOI] [PubMed] [Google Scholar]
  • 18. La Canna G, Rahimtoola SH, Visioli O, et al. Sensitivity, specificity, and predictive accuracies of noninvasive tests, singly and in combination, for diagnosis of hibernating myocardium. Eur Heart J 2000;21:1358–1367. [DOI] [PubMed] [Google Scholar]
  • 19. Rahimtoola SH. Coronary bypass surgery for chronic an‐gina‐1981. A perspective. Circulation 1982;65:225–241. [DOI] [PubMed] [Google Scholar]
  • 20. Rahimtoola SH. A perspective on the three large multi‐center randomized clinical trials of coronary bypass surgery for chronic stable angina. Circulation 1985;2:V123–V135. [PubMed] [Google Scholar]
  • 21. Elsasser A, Schkpper M, Klovekorn WP, et al. Hibernating myocardium: An incomplete adaptation to ischemia. Circulation 1997;96:2920–2931. [DOI] [PubMed] [Google Scholar]
  • 22. Gunning MG, Chua TP, Harrington D, et al. Hibernating myocardium: Clinical and functional response to revascularization. Eur J Cardiothorac Surg 1997;11:1105–1112. [DOI] [PubMed] [Google Scholar]
  • 23. Afridi I, Grayburn PA, Panza JA, et al. Myocardial viability during dobutamine echocardiography predicts survival in patients with coronary artery disease and severe left ventricular systolic dysfunction. J Am Coll Cardiol 1998;32: 921–926. [DOI] [PubMed] [Google Scholar]
  • 24. Oster HS, Taccardi B, Lux RL, et al. Electrocardiographic imaging: Noninvasive characterization of intramural myocardial activation from inverse‐reconstructed epicardial potentials and electrograms. Circulation 1998;97:1496–1507. [DOI] [PubMed] [Google Scholar]

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