(Circulation. 1997;96:2884-2891.)
© 1997 American Heart Association, Inc.
Articles |
Dependency of Contractile Reserve on Myocardial Blood Flow
Implications for the Assessment of Myocardial Viability With Dobutamine Stress Echocardiography
From the Cardiovascular Division, Department of Internal Medicine (H.H.L., V.G.D.-R., P.A.L., M.C., J.F.W., P.J.R., R.J.G.) and the Division of Nuclear Medicine, Edward Mallinckrodt Institute of Radiology (D.A.D., R.J.G.), Washington University School of Medicine, St Louis, Mo.
Correspondence to Robert J. Gropler, MD, Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, St Louis, MO 63110. E-mail gropler{at}mirlink.wustl.edu
Background Contractile reserve, improvement in contractile function during inotropic stimulation, is a proposed marker of viable myocardium. This study was designed to address, in patients with left ventricular dysfunction due to chronic coronary artery disease, whether contractile reserve depends on myocardial blood flow.
Methods and Results We studied 19 patients, at rest and during dobutamine, with 2D echocardiography for regional mechanical function and PET for regional myocardial blood flow ([15O]water) and oxygen consumption ([11C]acetate). Of 166 myocardial segments, 21 had normal systolic function, 56 were dysfunctional but contractile reserve–positive, and 89 were dysfunctional and contractile reserve–negative. Myocardial blood flow at rest was lower in contractile reserve–negative (0.41±0.18 mL · g-1 · min-1) than in contractile reserve–positive (0.50±0.22 mL · g-1 · min-1) and normal segments (0.55±0.20 mL · g-1 · min-1, P<.009). After dobutamine infusion, blood flow increased less in contractile reserve–negative (0.63±0.38 mL · g-1 · min-1) than in contractile reserve–positive (1.28±0.65 mL · g-1 · min-1) and normal segments (1.93±0.83 mL · g-1 · min-1, P<.0001). Likewise, myocardial oxygen consumption was lower at rest in contractile reserve–negative (clearance rate of [11C]acetate, 0.043±0.012 min-1) than in contractile reserve–positive (0.048±0.01 min-1) and normal segments (0.058±0.008 min-1, P<.02). Myocardial oxygen consumption with dobutamine increased less in contractile reserve–negative (0.060±0.013 min-1) than in contractile reserve–positive (0.077±0.016 min-1) and normal segments (0.092±0.024 min-1, P<.0001). Of segments defined as viable by PET, 54% were contractile reserve–negative and exhibited lower blood flow with dobutamine (0.72±0.36 mL · g-1 · min-1) than with viable, contractile reserve–positive segments (1.29±0.70 mL · g-1 · min-1, P<.0001).
Conclusions Contractile reserve depends, in part, on the level of myocardial blood flow at rest and during inotropic stimulation.
Key Words: tomography • myocardial contraction • echocardiography • coronary disease
This article has been cited by other articles:
 |
|
 |
|
  S. A. Cooper, A. Whaley-Connell, J. Habibi, Y. Wei, G. Lastra, C. Manrique, S. Stas, and J. R. Sowers Renin-angiotensin-aldosterone system and oxidative stress in cardiovascular insulin resistance Am J Physiol Heart Circ Physiol, October 1, 2007; 293(4): H2009 - H2023. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Cianfrocca, F. Pelliccia, A. Auriti, V. Guido, V. Pasceri, X. Li, G. Richichi, G. Mercuro, and M. Santini Levosimendan allows detection of contractile reserve in patients with chronic ischaemic left ventricular dysfunction and non-diagnostic dobutamine echocardiography Eur J Heart Fail, September 1, 2007; 9(9): 897 - 900. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. D. Banas, S. Baldwa, G. Suzuki, J. M. Canty Jr., and J. A. Fallavollita Determinants of contractile reserve in viable, chronically dysfunctional myocardium Am J Physiol Heart Circ Physiol, June 1, 2007; 292(6): H2791 - H2797. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. N. Mazzadi, X. Andre-Fouet, N. Costes, P. Croisille, D. Revel, and M. F. Janier Mechanisms leading to reversible mechanical dysfunction in severe CAD: alternatives to myocardial stunning Am J Physiol Heart Circ Physiol, December 1, 2006; 291(6): H2570 - H2582. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L A Pierard and P Lancellotti Determinants of persistent negative T waves and early versus late T wave normalisation after acute myocardial infarction Heart, August 1, 2005; 91(8): 1008 - 1012. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Heusch, R. Schulz, and S. H. Rahimtoola Myocardial hibernation: a delicate balance Am J Physiol Heart Circ Physiol, March 1, 2005; 288(3): H984 - H999. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Yoshinaga, C. Katoh, R. S.B. Beanlands, K. Noriyasu, K. Komuro, S. Yamada, Y. Kuge, K. Morita, A. Kitabatake, and N. Tamaki Reduced Oxidative Metabolic Response in Dysfunctional Myocardium with Preserved Glucose Metabolism but with Impaired Contractile Reserve J. Nucl. Med., November 1, 2004; 45(11): 1885 - 1891. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Wellnhofer, A. Olariu, C. Klein, M. Grafe, A. Wahl, E. Fleck, and E. Nagel Magnetic Resonance Low-Dose Dobutamine Test Is Superior to Scar Quantification for the Prediction of Functional Recovery Circulation, May 11, 2004; 109(18): 2172 - 2174. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Bianco, E. Tadamura, M. Yamamuro, S. Kubo, M. Mamede, and R. Sciagra Absolute Quantitation of Myocardial Blood Flow After Nitroglycerin and Ischemic Cardiomyopathy with a Low Ejection Fraction J. Nucl. Med., November 1, 2003; 44(11): 1872 - 1873. [Full Text]
|
|
|
|
|
|
T Hozumi, Y Kanzaki, Y Ueda, A Yamamuro, T Takagi, T Akasaka, S Homma, K Yoshida, and J Yoshikawa Coronary flow velocity analysis during short term follow up after coronary reperfusion: use of transthoracic Doppler echocardiography to predict regional wall motion recovery in patients with acute myocardial infarction Heart, October 1, 2003; 89(10): 1163 - 1168. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Shimoni, N. G. Frangogiannis, C. J. Aggeli, K. Shan, M. S. Verani, M. A. Quinones, R. Espada, G. V. Letsou, G. M. Lawrie, W. L. Winters, et al. Identification of Hibernating Myocardium With Quantitative Intravenous Myocardial Contrast Echocardiography: Comparison With Dobutamine Echocardiography and Thallium-201 Scintigraphy Circulation, February 4, 2003; 107(4): 538 - 544. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Fallavollita, B. J. Malm, and J. M. Canty Jr Hibernating Myocardium Retains Metabolic and Contractile Reserve Despite Regional Reductions in Flow, Function, and Oxygen Consumption at Rest Circ. Res., January 10, 2003; 92(1): 48 - 55. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. B. Chin, G. Esposito, and D. L. Kraitchman Myocardial Contractile Reserve and Perfusion Defect Severity with Rest and Stress Dobutamine 99mTc-Sestamibi SPECT in Canine Stunning and Subendocardial Infarction J. Nucl. Med., April 1, 2002; 43(4): 540 - 550. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P Lancellotti, A Albert, C Berthe, and L A Piérard Full recovery of contraction late after acute myocardial infarction: determinants and early predictors Heart, May 1, 2001; 85(5): 521 - 526. [Abstract] [Full Text]
|
|
|
|
 |
|
 J. Narula, M. S. Dawson, B. K. Singh, A. Amanullah, E. R. Acio, F. A. Chaudhry, R. B. Arani, and A. E. Iskandrian Noninvasive characterization of stunned, hibernating, remodeled and nonviable myocardium in ischemic cardiomyopathy J. Am. Coll. Cardiol., November 15, 2000; 36(6): 1913 - 1919. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G LaCanna, S.H Rahimtoola, O Visioli, R Giubbini, O Alfieri, M Zognio, E Milan, C Ceconi, M Gargano, R LoRusso, et al. Sensitivity, specificity, and predictive accuracies of non-invasive tests, singly and in combination, for diagnosis of hibernating myocardium Eur. Heart J., August 2, 2000; 21(16): 1358 - 1367. [Abstract] [PDF]
|
|
|
|
|
|
E. P. Hoffer, W. Dewe, C. Celentano, and L. A. Pierard Low-level exercise echocardiography detects contractile reserve and predicts reversible dysfunction after acute myocardial infarction: Comparison with low-dose dobutamine echocardiography J. Am. Coll. Cardiol., October 1, 1999; 34(4): 989 - 997. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. A. Chaudhry, J. T. Tauke, R. S. Alessandrini, G. Vardi, M. A. Parker, and R. O. Bonow Prognostic implications of myocardial contractile reserve in patients with coronary artery disease and left ventricular dysfunction J. Am. Coll. Cardiol., September 1, 1999; 34(3): 730 - 738. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Kawamoto, K. Yoshida, T. Akasaka, T. Hozumi, T. Takagi, S. Kaji, and Y. Ueda Can Coronary Blood Flow Velocity Pattern After Primary Percutaneous Transluminal Coronary Angiography Predict Recovery of Regional Left Ventricular Function in Patients With Acute Myocardial Infarction? Circulation, July 27, 1999; 100(4): 339 - 345. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Barilla, G. De Vincentis, E. Mangieri, M. Ciavolella, G. Pannitteri, F. Scopinaro, G. Critelli, and P. P. Campa Recovery of contractility of viable myocardium during inotropic stimulation is not dependent on an increase of myocardial blood flow in the absence of collateral filling J. Am. Coll. Cardiol., March 1, 1999; 33(3): 697 - 704. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. HEUSCH Hibernating Myocardium Physiol Rev, October 1, 1998; 78(4): 1055 - 1085. [Abstract] [Full Text] [PDF]
|
|