scholarly journals Can the 12-Lead Electrocardiogram Predict Myocardial Viability?

2021 ◽  
Author(s):  
Arpudh Michael Anandaraj ◽  
Lijo Varghese ◽  
Jesu Krupa ◽  
Binita Riya Chacko ◽  
Aparna Irodi ◽  
...  
Keyword(s):  
Wave Height ◽  
Myocardial Viability ◽  
Tamil Nadu ◽  
Anterior Wall ◽  
Left Ventricular ◽  
Viable Myocardium ◽  
Myocardial Infarctions ◽  
Predictive Values ◽  
Surface Ecg ◽  
Wave Heights

Introduction: In patients with coronary artery disease and left ventricular dysfunction, the assessment of myocardial viability, prior to revascularisation has been shown to be of significant benefit. Most methods to assess myocardial viability such as Positron Emission Tomography (PET) and Cardiac MRI (CMR) are not readily available in resource constrained settings. The present study sought to determine if an easily available and inexpensive tool, such as the 12-lead surface Electrocardiogram (ECG) can be used as a screening tool to assess for myocardial viability. It is hypothesised that the R wave height as a marker of electrical activity would correlate with viability. Aim: To determine if the surface ECG can be used to predict myocardial viability. Materials and Methods: This retrospective study was conducted at the Christian Medical College and Hospital, Vellore, Tamil Nadu, India. Among all patients who had undergone CMR viability assessment as part of their routine care between February 2008 and October 2017, and analysis and preliminary write up was done between November 2017 and Decemeber 2018, 119 patients with previous anterior wall myocardial infarctions were identified. The 12-Lead ECGs of these patients were assessed for the height of R wave in lead V3 and sum of R wave heights in all precordial leads. Myocardial viability was assessed based on the extent of Late Gadolinium Enhancement (LGE) on CMR. Measures of diagnostic accuracy including sensitivity, specificity, predictive values and likelihood ratios were calculated. Results: It was found that a R wave height of less than 3 mm in lead V3 was 90.3% sensitive for the detection of non viable myocardium. Similarly, when the sum of the R wave heights in all precordial leads was less than 28.5 mm, it was 93.2% sensitive for the detection of non viable myocardium. Conclusion: In patients with previous anterior wall myocardial infarctions when the R wave height was less than 3 mm in lead V3, it was 90.3 % sensitive to identify those with non viable Left Anterior Descending artery (LAD) territory. The 12-Lead ECG is therefore a sensitive, inexpensive and easily available screening test to assess for LAD territory non viability.

scholarly journals Incremental Value of Left Ventricular Mechanical Dyssynchrony Assessment by Nitrogen-13 Ammonia ECG-Gated PET in Patients With Coronary Artery Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Danzha Zheng ◽  
Yanyun Liu ◽  
Lei Zhang ◽  
Fan Hu ◽  
Xubo Tan ◽  
...  
Keyword(s):  
Myocardial Viability ◽  
Diagnostic Value ◽  
Mechanical Dyssynchrony ◽  
Left Ventricular ◽  
Viable Myocardium ◽  
Cardiac Events ◽  
Nitrogen 13 Ammonia ◽  
Group 3 ◽  
Group 2 ◽  
Artery Disease

Background: Phase analysis is a technique used to assess left ventricular mechanical dyssynchrony (LVMD) in nuclear myocardial imaging. Previous studies have found an association between LVMD and myocardial ischemia. We aim to assess the potential diagnostic value of LVMD in terms of myocardial viability, and ability to predict major adverse cardiac events (MACE), using Nitrogen-13 ammonia ECG-gated positron emission tomography (gPET).Methods: Patients with coronary artery disease (CAD) who underwent Nitrogen-13 ammonia and Fluorine-18 FDG myocardial gPET were enrolled, and their gPET imaging data were retrospectively analyzed. Patients were followed up and major adverse cardiac events (MACE) were recorded. The Kruskal-Wallis test and Mann-Whitney U test were performed to compare LVMD parameters among the groups. Binary logistic regression analysis, receiver operating characteristic (ROC) curve analysis, and multiple stepwise analysis curves were applied to identify the relationship between LVMD parameters and myocardial viability. Kaplan–Meier survival curves and the log-rank test were used to look for differences in the incidence of MACE.Results: In total, 79 patients were enrolled and divided into three groups: Group 1 (patients with only viable myocardium, n = 7), Group 2 (patients with more viable myocardium than scar, n = 33), and Group 3 (patients with less viable myocardium than scar, n = 39). All LVMD parameters were significantly different among groups. The median values of systolic phase standard deviation (PSD), systolic phase histogram bandwidth (PHB), diastolic PSD, and diastolic PHB between Group 1 and Group 3, and Group 2 and Group 3 were significantly different. A diastolic PHB of 204.5° was the best cut-off value to predict the presence of myocardial scar. In multiple stepwise analysis models, diastolic PSD, ischemic extent, and New York Heart Association (NYHA) classification were independent predictive factors of viable myocardium and myocardial scar. The incidence of MACE in patients with diastolic PHB > 204.5° was 25.0%, higher than patients with diastolic PHB <204.5° (11.8%), but the difference was not significant.Conclusions: LVMD generated from Nitrogen-13 ammonia ECG-gated myocardial perfusion imaging had added diagnostic value for myocardial viability assessment in CAD patients. LVMD did not show a definite prognostic value.

Echocardiography to assess viability

2015 ◽  
pp. 352-367
Author(s):  
Roxy Senior ◽  
Nuno Cortez Dias ◽  
Benoy N. Shah ◽  
Fausto J Pinto
Keyword(s):  
Myocardial Viability ◽  
Imaging Techniques ◽  
Large Body ◽  
Scar Tissue ◽  
Left Ventricular ◽  
Great Emphasis ◽  
Viable Myocardium ◽  
Cardioverter Defibrillator ◽  
Stich Trial ◽  
Developed Nations

The reduction in mortality from acute myocardial infarction in developed nations has resulted in a larger number of survivors with consequent left ventricular dysfunction. Management of these patients with ischaemic cardiomyopathy remains a challenge, since prognosis remains poor—and worse than that of non-ischaemic heart failure—despite appropriate use of implantable cardioverter-defibrillator and resynchronization devices. A large body of evidence accrued over the past three decades—predominantly retrospective in nature and observational in design—suggests that revascularization is superior to optimal medical therapy in patients with a large amount of ‘viable’ myocardium (i.e. dysfunctional myocardium at rest, which is not scar tissue and thus has, in theory, the potential to recover function after treatment). The global cardiology community has embraced this dogma, as many units worldwide place great emphasis upon the results of imaging tests (which aim to determine the presence and extent of myocardial ‘viability’) in guiding management strategy—specifically, whether to offer or deny a patient revascularization. This practice has been challenged recently by the results of the STICH trials, which suggested both lack of benefit from revascularization and no incremental benefit from viability testing. A number of imaging techniques exist for identifying viable myocardium. This chapter reviews the echocardiographic modalities that can be used to identify viable myocardium and compare these with other available techniques. We also analyse the results of the main STICH trial and the STICH viability sub-study and suggest an algorithm for integration of multi-modality imaging in the evaluation of myocardial viability.

scholarly journals P773 Can strain imaging predict viability in ST segment elevation myocardial infarction patient

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
F Mghaieth Zghal ◽  
S Habboubi ◽  
S Boudiche ◽  
M Ben Halima ◽  
B Rekik ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Phase ◽  
Myocardial Viability ◽  
Global Longitudinal Strain ◽  
Reference Method ◽  
Strain Imaging ◽  
Left Ventricular ◽  
Viable Myocardium ◽  
Lv Function ◽  
2D Strain

Abstract Background In the acute phase of ST elevation myocardial infarction (STEMI), the main objective is to recanalize the guilty artery, but it is important to know whether myocardium with severely compromised function is permanently injured or reversibly dysfunctional indicating myocardial viability. On the other hand, viability tests such as scintigraphy, magnetic resonance imaging with delayed enhanced (DE-MRI) or dobutamine stress echography are either not validated or unavailable in the acute phase of STEMI. The assessment of myocardial deformation by bidimensional strain (2D) is a technique that has emerged in recent years with good correlation with MRI for viability assessment. An important question remains : Is myocardial viability can be determined by 2D strain parameters at the acute phase of STEMI ? Aim : To assess myocardial viability in the acute phase of STEMI by 2D strain echocardiographic parameters in comparison with 3 month DE-MRI as a reference method. Methods A total of 31 first STEMI patients treated with successful primary or elective percutaneous coronary intervention (PCI) were included with an akinetic area on echocardiography corresponding to the infarct segments. Doppler strain values from left ventricular basal, mid and apical segments (n= 527) were obtained at the acute phase of STEMI and checked up after 3 months. The scar was assessed for viability by DE-MR as reference method, 3 months after the acute phase. Viability was defined by a DE < 50% of wall thickness in the scar zone. Results Mean age of the study population was 59,29 ±9,96 years , 27 (87%) being males. Nine patients (29%) showed post-PCI improvement of left ventricule (LV) function. Regional peak systolic strain of the infarct segments and global longitudinal strain (GLS) after 3 months. At the acute phase, wall motion score index (WMSI), regional and global strain values were signficantly better in the viable than in the non viable segments. GLS was -10,92 ± 2,48 in patients with MRI non viable myocardium and -14,45 ±2,91 in patients with MRI viable myocardium . A pre-PCI strain value of -2,9% as a cutt off predicted segmental function recovery after PCI and myocardial viability with a sensitivity 82% of and a specificity 84%. Conclusion : This monocenter study confirms that 2D strain imaging can be a usueful and accurate method to predict myocardial viability and recovery of segmental and global LV function after PCI in STEMI patients.

Correlation between cardiac remodelling, function, and myocardial contractility in rat hearts 5 weeks after myocardial infarction

1998 ◽  
Vol 76 (1) ◽  
pp. 53-62 ◽  
Author(s):  
H Gosselin ◽  
X Qi ◽  
J L Rouleau
Keyword(s):  
Ventricular Function ◽  
Papillary Muscle ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Viable Myocardium ◽  
Myocardial Infarctions ◽  
Muscle Dysfunction ◽  
Ventricular Wall ◽  
Ventricular Remodelling ◽  
Papillary Muscle Dysfunction

Early after infarction, ventricular dysfunction occurs as a result of loss of myocardial tissue. Although papillary muscle studies suggest that reduced myocardial contractility contributes to this ventricular dysfunction, in vivo studies indicate that at rest, cardiac output is normal or near normal, suggesting that contractility of the remaining viable myocardium of the ventricular wall is preserved. However, this has never been verified. To explore this further, 100 rats with various-sized myocardial infarctions had ventricular function assessed by Langendorff preparation or by isolated papillary muscle studies 5 weeks after infarction. Morphologic studies were also done. Rats with large infarctions (54%) had marked ventricular dilatation (dilatation index from 0.23 to 0.75, p << 0.01) and papillary muscle dysfunction (total tension from 6.7 to 3.2 g/mm2, p << 0.01) but only moderate left ventricular dysfunction (maximum developed tension from 206 to 151 mmHg (1 mmHg = 133.3 Pa), p << 0.01), a decrease less than one would expect with an infarct size of 54%. The contractility of the remaining viable myocardium of the ventricle was also moderately depressed (peak systolic midwall stress 91 to 60 mmHg, p << 0.01). Rats with moderate infarctions (32%) had less marked but still moderate ventricular dilatation (dilatation index 0.37, p << 0.001) and moderate papillary muscle dysfunction (total tension 4.2 g/mm2, p << 0.01). However, their decrease in ventricular function was only mild (maximum developed pressure 178 mmHg, p << 0.01) and less than one would expect with an infarct size of 32%. The remaining viable myocardium of the ventricular wall appeared to have normal contractility (peak systolic midwall stress = 86 mmHg, ns). We conclude that in this postinfarction model, in large myocardial infarctions, a loss of contractility of the remaining viable myocardium of the ventricular wall occurs as early as 5 weeks after infarction and that papillary muscle studies slightly overestimate the degree of ventricular dysfunction. In moderate infarctions, the remaining viable myocardium of the ventricular wall has preserved contractility while papillary muscle function is depressed. In this relatively early postinfarction phase, ventricular remodelling appears to help maintain left ventricular function in both moderate and large infarctions. Key words: postinfarction, contractility, ventricular function, ventricular remodelling.

scholarly journals Perfusion Computed Tomography for the Assessment of Myocardial Viability — a Case Series

2016 ◽  
Vol 1 (1) ◽  
pp. 83-87
Author(s):  
Mirabela Morariu ◽  
Diana Opincariu ◽  
Alexandra Stănescu
Keyword(s):  
Computed Tomography ◽  
Coronary Angiography ◽  
Myocardial Perfusion ◽  
Myocardial Viability ◽  
Stress Test ◽  
Left Ventricular ◽  
Ct Coronary Angiography ◽  
Viable Myocardium ◽  
Adenosine Stress ◽  
Emission Computed Tomography

Abstract Myocardial viability plays an important role in preventing the development of left ventricular remodeling following an acute myocardial infarction. A preserved viability in the infarcted area has been demonstrated to be associated with a lower amplitude of the remodeling process, while the extent of the non-viable myocardium is directly correlated with the amplitude of the remodeling process. A number of methods are currently in use for the quantification of the viable myocardium, and some of them are based on the estimation of myocardial perfusion during pharmacologic stress. 64-slice Multi-detector Computed Tomography (MDCT) during vasodilator stress test, associated with CT Coronary Angiography (CCTA) has a high diagnostic accuracy in evaluating myocardial perfusion. In this article, we present a sequence of 3 clinical cases that presented with symptoms of myocardial ischemia, who underwent 64-slice MDCT imaging at rest and during adenosine stress test, in order to assess the extent of the hypoperfused myocardial areas. Coronary artery anatomy and the Coronary Calcium Score was assessed for all 3 patients by performing CT Coronary Angiography. The combination of CT Angiography and adenosine stress CT myocardial perfusion imaging can accurately detect atherosclerosic lesions that cause perfusion abnormalities, compared with the combination of invasive angiography and single-photon emission computed tomography (SPECT).

Evaluation of Myocardial Viability – Contrast and Stress Echocardiography

2011 ◽  
Vol 3 (1) ◽  
pp. 13 ◽  
Author(s):  
Melissa Leung ◽  
Dominic Y Leung ◽  
◽  
Keyword(s):  
Myocardial Viability ◽  
Stress Echocardiography ◽  
Contrast Echocardiography ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Viable Myocardium ◽  
Hibernating Myocardium ◽  
Risk Of Death ◽  
Research Activities ◽  
Increased Risk

Viable myocardium are myocardial segments with reduced function that often appear dyssynergic. These dyssynergic myocardial segments are capable of functional recovery, either spontaneously or after the offending insult, usually ischaemia, is removed by revascularisation. Patients with impaired left ventricular function but with viable myocardium are at increased risk of death and adverse cardiovascular outcome. The detection and recognition of viable myocardium is critical for risk stratification, guiding the selection of patients likely to benefit from revascularisation and predicting left ventricular remodelling. Contrast and stress echocardiography are important clinical tools for the assessment of myocardial viability. An end diastolic wall thickness of <0.6cm at the dyssynergic segments generally indicates scarring. The presence of post-systolic thickening at these segments suggests either myocardial viability or ischaemia. Useful in assessing contractile reserve in dyssynergic segments, dobutamine echocardiography is an established tool for detecting myocardial viability with accuracies comparable to other techniques. A biphasic response is diagnostic and specific for hibernating myocardium. The newer techniques of strain and strain rate imaging are the focus of research activities and have been used in conjunction with dobutamine stress to improve overall accuracy. Myocardial contrast echocardiography (MCE) is useful in assessing coronary microvascular integrity, a pre-requisite for myocardial viability. The presence of an intact coronary microvasculature alone is insufficient for myocardial viability, however, explaining the high sensitivity but low specificity of MCE for such purposes. MCE, therefore, with its high negative predictive value, should be used in conjunction with dobutamine stress for the identification of viable myocardium. Due to its availability, safety, relatively low costs and high accuracy, rest and stress echocardiography are indispensable tools in the assessment of myocardial viability.

scholarly journals Myocardial Viability: What We Knew and What Is New

2012 ◽  
Vol 2012 ◽  
pp. 1-13 ◽  
Author(s):  
Adel Shabana ◽  
Ayman El-Menyar
Keyword(s):  
Myocardial Viability ◽  
Intact Cell ◽  
Imaging Techniques ◽  
Left Ventricular ◽  
Viable Myocardium ◽  
Contractile Reserve ◽  
Lv Dysfunction ◽  
Positron Emission ◽  
Artery Disease ◽  
Long Term Prognosis

Some patients with chronic ischemic left ventricular dysfunction have shown significant improvements of contractility with favorable long-term prognosis after revascularization. Several imaging techniques are available for the assessment of viable myocardium, based on the detection of preserved perfusion, preserved glucose metabolism, intact cell membrane and mitochondria, and presence of contractile reserve. Nuclear cardiology techniques, dobutamine echocardiography and positron emission tomography are used to assess myocardial viability. In recent years, new advances have improved methods of detecting myocardial viability. This paper summarizes the pathophysiology, methods, and impact of detection of myocardial viability, concentrating on recent advances in such methods. We reviewed the literature using search engines MIDLINE, SCOUPS, and EMBASE from 1988 to February 2012. We used key words: myocardial viability, hibernation, stunning, and ischemic cardiomyopathy. Recent studies showed that the presence of viable myocardium was associated with a greater likelihood of survival in patients with coronary artery disease and LV dysfunction, but the assessment of myocardial viability did not identify patients with survival benefit from revascularization, as compared with medical therapy alone. This topic is still debatable and needs more evidence.

scholarly journals Hybrid Imaging in the Assessment of Myocardial Ischemia and Viability

2016 ◽  
Vol 1 (3) ◽  
pp. 242-246
Author(s):  
Alexandra Stănescu ◽  
Diana Opincariu ◽  
Nora Rat ◽  
Mirabela Morariu ◽  
Sebastian Condrea ◽  
...  
Keyword(s):  
Myocardial Ischemia ◽  
Myocardial Viability ◽  
Hybrid Imaging ◽  
Imaging Techniques ◽  
Left Ventricular ◽  
Viable Myocardium ◽  
Hibernating Myocardium ◽  
Myocardial Tissue ◽  
Single Image ◽  
New Methods

Abstract Myocardial ischemia results from a reduction in blood flow as a consequence of a coronary stenosis, which produces ischemia in the myocardial territories irrigated by the stenotic artery. Myocardial viability is a concept that derived from several studies in which it was observed that, even if revascularization occurred, an irreversible left ventricular contractile dysfunction remained. The terms “stunned” and “hibernating” myocardium have been traditionally associated with the viable myocardium, and many controversies still exist on the most appropriate method to assess the presence and extent of viable myocardium. During the last decades, many efforts have been made to identify the best method to determine the viability of the myocardial tissue. Due to the fact that none of the stand-alone imaging methods provide sufficient data about myocardial viability, new methods for the investigation of myocardial viability became necessary. Thus, the concept of hybrid imaging was developed, consisting in the association of different imaging techniques, finally resulting in a single image that offers all the details provided by the two isolated methods of diagnosis, therefore being more precise in regards to the identification of viable myocardium territory. This review aims to appraise the recent studies related to myocardial viability investigated with hybrid imaging.

Vergleich von Belastungs- EKG und Radionuklid- Ventrikulographie bezüglich des Nachweises einer Myokardischämie bei isolierten Stenosen des Ramus interventricularis anterior

1988 ◽  
Vol 27 (02) ◽  
pp. 57-62
Author(s):  
R. Standke ◽  
R. P. Baum ◽  
S. Tezak ◽  
D. Mildenberger ◽  
F. D. Maul ◽  
...  
Keyword(s):  
Heart Disease ◽  
Left Ventricular Ejection Fraction ◽  
Myocardial Ischemia ◽  
Ejection Fraction ◽  
Anterior Wall ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Global Ejection Fraction ◽  
Ventricular Ejection Fraction ◽  
Exercise Ecg

21 patients with LAD-stenoses of at least 70% and 21 patients with LAD- stenoses and additional intramural anterior wall infarctions were studied. 20 patients without heart disease or after successful transluminal coronary angioplasty and 18 patients with intramural anterior wall infarction after successful transluminal dilatation of the LAD (remaining stenosis maximal 30%) served as controls. The normal range of global and regional left ventricular ejection fraction response to exercise was defined based on the data of 25 further patients without relevant coronary heart disease. Thus, a decrease in global ejection fraction and regional wall motion abnormalities were judged pathological. All patients were comparable with respect to age, ejection fraction at rest and work load. Myocardial ischemia could be detected by the exercise ECG in 81 % of all patients without infarction and in 71 % of patients with infarction. The corresponding values for global left ventricular ejection fraction were 76% and 81 %, respectively, and for regional ejection fraction 95% in both groups. No false-positive exercise ECGs were observed in the healthy controls and 2 (11 %) in the corresponding group with intramural infarction. The global ejection fraction was pathological in 1 (5%) healthy subject without infarction and in 3 (17%) corresponding patients with infarction. Sectorial analysis revealed 5 and 22%, respectively. Our findings suggest that the exercise ECG has a limited sensitivity to detect myocardial ischemia in patients with isolated LAD-stenoses and intramural myocardial infarction. Radionuclide ventriculography yields pathological values more often; however, false-positive results also occur more frequently.

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