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Patients With Hibernating Myocardium Show Altered Left Ventricular Volumes and Shape, Which Revert After Revascularization

Evidence That Dyssynergy Might Directly Induce Cardiac Remodeling

Erberto Carluccio, MD^_*, Paolo Biagioli, MD^_*, Gianfranco Alunni, MD^_*, Adriano Murrone, MD^_*, Claudio Giombolini, MD^_*, Temistocle Ragni, MD, Paolo N. Marino, MD, Gianpaolo Reboldi, MD, PhD, MSc and Giuseppe Ambrosio, MD, PhD, FACC^_*,_*

^_* Department of Cardiology, University of Perugia School of Medicine, Perugia, Italy
Department of Cardiac Surgery, University of Perugia School of Medicine, Perugia, Italy
Department of Internal Medicine, University of Perugia School of Medicine, Perugia, Italy
Division of Cardiology, University of Piemonte Orientale, Novara, Italy

View larger version (27K): [in a new window]   Figure 1 Individual changes in end-systolic volume index (ESVI), end-diastolic volume index (EDVI), and sphericity index (SI) from baseline to follow-up after revascularization. Bars = mean ± SD.

View larger version (35K): [in a new window]   Figure 2 Correlations between echocardiographic indices of viability and changes in ESVI (upper panels) or EDVI (bottom panels), from baseline to follow-up. (Upper panels) (A) DeltaESVI = 5.576 + (–5.472 x no. of viable segments); standard error of estimate (SEE) = 6.6; (B) DeltaESVI = 3.601 + (–62.13 x viability index); SEE = 6.9; (C) DeltaESVI = 0.9636 + (–5.183 x no. of recovered segments); SEE = 4.3. (Bottom panels) (A) DeltaEDVI = 4.3256 + (–3.3366 x no. of viable segments); SEE = 5.6; (B) DeltaEDVI = 4.9007 + (–41.6070 x viability index); SEE = 5.61; (C) DeltaEDVI = 0.2879 + (–2.9370 x no. of recovered segments); SEE = 4.11. Abbreviations as in Figure 1.

View larger version (14K): [in a new window]   Figure 3 Correlations between absolute values of end-systolic volume index (ESVI) and wall motion score index (WMSI), at baseline (left; r = 0.39, p < 0.05) and at follow-up (right; r = 0.66, p < 0.0001).

View larger version (14K): [in a new window]   Figure 4 Percent changes in left ventricular volumes and geometry at follow-up according to presence of viability (Viab+) or absence of viability (Viab–) during dobutamine echocardiography before revascularization. EDVI = end-diastolic volume index; ESVI = end-systolic volume index; SI = sphericity index.

View larger version (70K): [in a new window]   Figure 5 Two-dimensional apical four-chamber view of left ventricular (LV) end-diastolic and end-systolic cavity silhouettes at baseline (left) and >4 months after revascularization (right). (A) In a patient with no viable myocardium (viability index = 0.13), no recovery of function and no reverse remodeling at follow-up. (B) In a patient with substantial myocardial viability (viability index = 0.56) and eight segments that recovered function after revascularization. Marked reduction of LV end-diastolic and end-systolic volumes is appreciable at follow-up examination.