Volume 4, Issue 3, September 2020, Page: 92-98
Extracellular Volume Estimation in the Assessment of Myocardial Viability in Ischaemic Cardiomyopathy
Atul Kapur, Department of Radiology, Advanced Diagnostics and Institute of Imaging 17/8, Amritsar, Punjab, India
Goldaa Mahajan, Department of Radiology, Advanced Diagnostics and Institute of Imaging 17/8, Amritsar, Punjab, India
Aprajita Kapur, Department of Radiology, Advanced Diagnostics and Institute of Imaging 17/8, Amritsar, Punjab, India
Received: Apr. 30, 2020;       Accepted: Jun. 11, 2020;       Published: Jun. 28, 2020
DOI: 10.11648/j.ccr.20200403.13      View  27      Downloads  14
OBJECTIVES: To determine the role of extracellular volume estimation (ECV) along with Late gadolinium enhanced (LGE) MRI in assessing viability in patients with chronic ischemic cardiomyopathy. BACKGROUND: Imaging techniques form myocardial viability estimation have shown varying results and outcomes in patients with chronic ischemic cardiomyopathy. In the current form viability estimation is being questioned as a single important prognostic prerevascularisation variable. Hence there is a need to explore new and a robust technique to achieve the above goal. METHODS: 22 consecutive patients diagnosed with chronic ischemic cardiomyopathy which were considered for bypass grafting and had angiographic proven triple vessel disease and or left main stenosis with reduced ejection fraction of <35% were enrolled in the study. CMR was done using ECV and LGE protocol. All patients had normal renal functions. Viability (V) scores and Corrected Viability (CV) scores were calculated on LGE and ECV –LGE images. Segments with ECV>50% were labeled as nonviable. Six month primary outcome measure was improved ejection fraction following revascularisation. RESULTS: Sensitivity and specificities for detection of nonviable segments on LGE and ECV-LGE were 69%, 100%and 96%, 100% with AUC’s being 0.84 and 0.98 respectively. Patients with CV score of >8 showed positive primary outcome of improved ejection fraction of 42.8% while those with CV score<8 showed a negative primary outcome. Group II patients with viable myocardium with significant fibrous tissue i.e. ECV of 28-49% showed partially improved function. CONCLUSION: Estimation of ECV-LGE method had 96% sensitivity in the detection of nonviable segments and also showed a positive primary outcome with improved ejection fraction at six months with viability being a Bayesian variable which depended upon the quantity of fibrous tissue in the viable myocardium.
Ischemic Cardiomyopathy, Myocardial Viability, Cardiac MRI, Extra Cellular Volume
To cite this article
Atul Kapur, Goldaa Mahajan, Aprajita Kapur, Extracellular Volume Estimation in the Assessment of Myocardial Viability in Ischaemic Cardiomyopathy, Cardiology and Cardiovascular Research. Vol. 4, No. 3, 2020, pp. 92-98. doi: 10.11648/j.ccr.20200403.13
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Baker D, Jones R, Hodges J, et al. Management of Heart Failure. III. The role of revascularization in the treatment of patients with moderate or severe left ventricular systolic dysfunction. JAMA. 1994; 272: 1158–1134.
Coronary artery surgery study (CASS): a randomized trial of coronary artery bypass surgery. Survival data. Circulation1983; 68: 939-50. 10.1161/01.CIR.68.5.939.
Travin MI, Bergmann SR. Assessment of myocardial viability. Semin Nucl Med. 2005; 2: 2–19.
Bruder O. Wagner A. Jensen C. J., et al. Myocardial scar visualized by cardiovascular magnetic resonance imaging predicts major adverse events in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol. 2010. 56: 875–887.
Kidambi A, Motwani M, Uddin A, Ripley DP, etal. Myocardial Extracellular Volume Estimation by CMR Predicts Functional Recovery Following Acute MI. JACC 2016.10: 989-999.
Ichiro M, Junichi T, Kenichi N, Norihisa T, Kinichi H. Myocardial viability assessment using nuclear imaging. Ann Nucl Med. 2003; 17: 169–179.
Velazquez EJ, Lee KL, O’Connor CM, et al. The rationale and design of the Surgical Treatment for Ischemic Heart Failure (STICH) trial. J Thorac Cardiovasc Surg 2007; 134: 1540-7.
Velazquez EJ, Lee KL, Deja MA, et al. Coronary-artery bypass surgery in patients with left ventricular dysfunction. N Engl J Med2011; 364: 1607-16.
Abraham A, Nichol G, Williams KA, Guo A, de Kemp RA, Garrard L, et al; PARR 2 Investigators. 18F-FDG PET imaging of myocardial viability in an experienced center with access to 18F-FDG and integration with clinical management teams: the Ottawa-FIVE substudy of the PARR 2 trial. J Nucl Med. 2010; 51 (4): 567-74.
Beanlands R. S. B., Nichol G., Huszti E., et al. PARR-2 Investigators. F-18-fluorodeoxyglucose positron emission tomography imaging-assisted management of patients with severe left ventricular dysfunction and suspected coronary disease: a randomized, controlled trial (PARR-2) J Am Coll Cardiol. 2007; 50: 2002–2012.
Kim RJ, Shah DJ. Fundamental concepts in myocardial viability assessment revisited: when knowing how much is ‘‘alive’’ is not enough. Heart 2004; 90: 137–140.
Ramos M, De Pasquale E, Coplan NL. Assessment of myocardial viability: review of the clinical significance. Rev Cardiovasc Med. 2008; 9: 225–231.
Beller GA, Gimple LW. Myocardial viability. Assessment by cardiac scintigraphy. Cardiol Clin. 1994 May; 12 (2): 317-32.
Wilter SK, Nunes TP, Nacif MS, Mesquita T. Practical Implications of Myocardial Viability Studies. Arq Bras Cardiol. 2018; 110 (3): 278-288.
Miller CA, Naish JH, Bishop P, Coutts G, Clark D, Zhao S, Ray SG, Yonan N, Williams SG, Flett AS, et al.. Comprehensive validation of cardiovascular magnetic resonance techniques for the assessment of myocardial extracellular volume. Circ Cardiovasc Imaging. 2013; 6: 373–383.
Puntmann VO, Carr-White G, Jabbour A, Yu CY, Gebker R, Kelle S, Hinojar R, Doltra A, Varma N, Child N, et al. T1-Mapping and Outcome in Nonischemic Cardiomyopathy: All-Cause Mortality and Heart Failure. JACC Cardiovasc Imaging. 2016 Jan; 9 (1): 40-50.
Pellikka PA, Nagueh SF,. Elhendy AA, Kuehl CA, Sawada SG. “American Society of Echocardiography recommendations for performance, interpretation, and application of stress echocardiography,” Journal of the American Society of Echocardiography 2007; 20: 9, 1021–1041.
Gropler RJ, Bergman SR. Myocardial Viability “What Is the Definition”. J Nucl Med. 1991; 32: 10-12.
Bax JJ, Poldermans D. Clinical value of assessment of perfusion and function for the evaluation of myocardial viability in patients with ischemic left ventricular dysfunction. In: Germano G, Berman DS, eds. In: Clinical Gated Cardiac SPECT 2nd ed. Massachusetts: Blackwell Publishing Ltd; 2006: 260.
Treasure CB, Klein JL, Vita JA, et al. Hypertension and left ventricular hypertrophy are associated with impaired endothelium-mediated relaxation in human coronary resistance vessels. Circulation. 1993; 87: 86–93.
Frangogiannis NG. The Extracellular Matrix in Ischemic and Nonischemic Heart Failure. Circulation Research 2019; 117-146.
Redfors B, Stone GW. Myocardial viability and CABG surgery: a Bayesian appraisal of STICH. Nat Rev Cardiol. 2019 Dec; 16 (12): 702-703.
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