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CLINICAL STUDY: CARDIOMYOPATHY

Noninvasive characterization of stunned, hibernating, remodeled and nonviable myocardium in ischemic cardiomyopathy

^a Department of Medicine, Hahnemann University School of Medicine, Philadelphia, Pennsylvania, USA

Manuscript received February 9, 1999; revised manuscript received May 15, 2000, accepted July 12, 2000.

Reprint requests and correspondence: Dr. Ami E. Iskandrian, Division of Cardiovascular Diseases, University of Alabama at Birmingham, 318LHRB, 1900 University Boulevard, Birmingham, Alabama 35294-0006
aiskand{at}uab.edu

OBJECTIVES

We evaluated a novel protocol of dual-isotope, gated single-photon emission computed tomographic (SPECT) imaging combined with low and high dose dobutamine as a single test for the characterization of various types of altered myocardial dysfunction.

BACKGROUND

Myocardial perfusion tomography and echocardiography have been used separately for the assessment of myocardial viability. However, it is possible to assess perfusion, function and contractile reserve using gated SPECT imaging.

METHODS

We studied 54 patients with ischemic cardiomyopathy using rest and 4 h redistribution thallium-201 imaging and dobutamine technetium-99m sestamibi SPECT imaging. The sestamibi images were acquired 1 h after infusion of the maximal tolerated dose of dobutamine and again during infusion of dobutamine at a low dose to estimate contractile reserve. Myocardial segments were defined as hibernating, stunned, remodeled or scarred.

RESULTS

Severe regional dysfunction was present in 584 (54%) of 1,080 segments. Based on the combination of function and perfusion characteristics in these 584 segments, 24% (n = 140) were labeled as hibernating; 23% (n = 136) as stunned; 30% (n = 177) as remodeled; and 22% (n = 131) as scarred. Contractile reserve, represented by improvement in wall motion/thickening by low dose dobutamine, was observed in 83% of stunned, 59% of hibernating, 35% of remodeled and 13% of scarred myocardial segments (p < 0.05).

CONCLUSIONS

It is possible with this new imaging technique to characterize dysfunctional myocardium as stunned, hibernating, remodeled and nonviable. These subtypes often coexist in the same patient.

Abbreviations and Acronyms   CAD = coronary artery disease   EF = ejection fraction   LV = left ventricular   PET = positron emission tomography   SPECT = single-photon emission computed tomography   Tl-201 = thallium-201   Tc-99m = technetium-99m

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