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Circulation, Vol 85, 1347-1353, Copyright © 1992 by American Heart Association
TH Marwick, WJ MacIntyre, A Lafont, JJ Nemec and EE Salcedo
BACKGROUND. The presence of persistent myocardial uptake of 18F-
deoxyglucose (FDG) within hypoperfused, dysfunctional segments has been
shown to predict the recovery of regional contractile function after
revascularization. The spectrum of metabolic responses of such hibernating
tissue to revascularization is less clear. METHODS AND RESULTS. Sixteen
patients with previous infarction were studied before and after
revascularization by myocardial perfusion imaging using 82Rb positron
emission tomography, digitized two-dimensional echocardiography, and
imaging of postexercise FDG uptake. Hibernation was identified in 35 of 85
segments showing perfusion and wall motion disturbances before
intervention. At follow-up (4.9 +/- 2.6 months after revascularization),
hibernating segments were characterized by reduction of wall motion score
(p less than 0.001), improvement of perfusion (p less than 0.001), and
reduction of FDG activity (p less than 0.001). Of the 35 hibernating
segments, however, 10 still had abnormal elevation of FDG uptake (greater
than 2 SD above normal) without differing from other hibernating segments
with respect to postoperative perfusion or wall motion score. Segments with
persistently abnormal metabolism were characterized before intervention by
more severe malperfusion (p less than 0.01) and greater FDG activity (p
less than 0.01). CONCLUSIONS. Although wall motion and perfusion improve
with revascularization of hibernating tissue, myocardial metabolism remains
abnormal in a significant proportion of segments. These segments are
characterized by more extensive perfusion and metabolic changes before
revascularization.
ARTICLES
Metabolic responses of hibernating and infarcted myocardium to revascularization. A follow-up study of regional perfusion, function, and metabolism
Department of Cardiology, Cleveland Clinic Foundation, Ohio.
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