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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^_*,_*

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

View larger version (17K): [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 (22K): [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 (9K): [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.