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CLINICAL STUDY: CORONARY ARTERY DISEASE

Evidence of reduced resting blood flow in viable myocardial regions with chronic asynergy

^a Departments of Medicine (Cardiac Unit), Radiology and Nuclear Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA

Manuscript received December 23, 1999; revised manuscript received June 28, 2000, accepted August 11, 2000.

Reprint requests and correspondence: Dr. Henry Gewirtz, Cardiac Unit/Vincent Burnham 3, Massachusetts General Hospital, Boston, Massachusetts 02114
gewirtz.henry{at}mgh.harvard.edu

OBJECTIVES

We tested the hypothesis in patients (n = 24) with ischemic heart disease that chronic contractile dysfunction occurs in myocardial regions with true reduction in rest blood flow.

BACKGROUND

Whether viable myocardial regions with chronic contractile dysfunction have true reduction in rest myocardial blood flow is controversial.

METHODS

Positron emission tomography (PET) ¹³N-ammonia was used to measure myocardial blood flow in combination with ¹⁸F-fluorodeoxyglucose (¹⁸FDG) to assess myocardial viability. Viability also was assessed by dobutamine echo and recovery of function after coronary artery bypass grafting (CABG). Segments (n = 252) were selected based on PET measured reduced resting blood flow and rest asynergy on echo.

RESULTS

Regional myocardial viability was present in 20 of 23 patients by PET, 13 of 23 by dobutamine echo and 10 of 11 by postrevascularization criteria. Rest blood flow in normal regions was 1.14 ± 0.52 ml/min/g and by definition exceeded (p < 0.005) that in both viable (0.48 ± 0.15; n = 8 patients) and nonviable (0.45 ± 0.14; n = 8 patients) regions (post-CABG criteria), which did not differ. Correction of rest myocardial blood flow in viable asynergic segments, only, for fibrosis and incomplete tracer recovery raised the level to 0.67 ± 0.21 (p < 0.005 vs. normal). Finally, evidence of both stunning (rest asynergy with normal flow) and hibernation was present in 15 of 23 (65%) patients.

CONCLUSIONS

Reduced rest blood flow in viable myocardial regions with chronic asynergy is common and cannot be accounted for by partial volume effect. Thus, hypotheses concerning physiologic mechanisms underlying chronic contractile dysfunction should consider the role played by chronic reduction of basal myocardial blood flow.

Abbreviations and Acronyms   ANOVA = analysis of variance   BP = blood pressure   CABG = coronary artery bypass grafting   CAD = coronary artery disease   18FDG = 18F-fluorodeoxyglucose   IV = intravenous   LV = left ventricle, left ventricular   MI = myocardial infarction   PET = positron emission tomography   ROI = region of interest

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