Characterization of hibernating myocardium with NOGA electroanatomic endocardial mapping
Mariann Gyöngyösi1, Aliasghar Khorsand, Heinz Sochor
1Department of Cardiology, University of Vienna, Vienna, Austria. mariann.gyongyosi@meduniwien.ac.at
Insights
NOGA electroanatomic mapping can identify hibernating myocardium in viable heart segments. This technique provides guidance for myocardial revascularization procedures, improving patient outcomes.
Area of Science:
- Cardiology
- Medical Imaging
- Electrophysiology
Background:
- Distinguishing hibernating myocardium from non-viable tissue is crucial for effective treatment.
- NOGA electroanatomic endocardial mapping has shown potential but requires further characterization for hibernating myocardium.
Purpose of the Study:
- To define the electrophysiological and functional characteristics of hibernating myocardium using NOGA mapping.
- To assess the role of NOGA mapping in guiding myocardial revascularization.
Main Methods:
- NOGA electroanatomic endocardial mapping, thallium-201 myocardial perfusion scintigraphy, and contrast ventriculography were performed in 28 patients.
- Patients underwent baseline and follow-up assessments post-percutaneous coronary intervention.
Main Results:
- Hibernating myocardial segments showed higher baseline unipolar voltages and late thallium uptake.
- NOGA mapping identified a mean unipolar voltage of 9.0 mV for predicting functional recovery with 72% sensitivity and specificity.
- Improved regional wall motion and local linear shortening were observed in patients with successful revascularization.
Conclusions:
- NOGA endocardial mapping is valuable for characterizing hibernating myocardium within viable segments.
- The study provides on-line guidance for percutaneous coronary and noncoronary myocardial revascularization procedures.
Abstract:
Because the terms "hibernation" and "viability" are not interchangeable, the recognition of hibernating myocardium within viable segments remained elusive for NOGA electroanatomic endocardial mapping. The aim of the present study was to determine the characteristics of hibernating myocardium in NOGA mapping. Baseline and follow-up endocardial mapping, thallium-201 myocardial perfusion scintigraphy at rest, and contrast ventriculography were performed in 28 patients who had proved viable myocardium before and 7.3 +/- 2.5 months after percutaneous coronary intervention. Significantly improved regional wall motion in the revascularized territory (region of interest) was confirmed in 9 patients (group 1) at follow-up (from -2.11 +/- 0.87 to -1.48 +/- 0.43 SD/chord, p <0.05), whereas no change in regional wall motion was observed in 19 patients (group 2; from -2.56 +/- 0.88 to -2.79 +/- 0.91 SD/chord). Average normalized thallium uptake at rest increased significantly in groups 1 and 2 after revascularization. A trend toward increased unipolar voltages in the region of interest was observed in group 1 at follow-up (from 10.6 +/- 3.5 to 11.7 +/- 4.0 mV, p = 0.073), whereas no change was observed in group 2 (from 8.7 +/- 4.4 to 8.9 +/- 3.8 mV). A significant increase in local linear shortening was measured only in group 1 (from 7.5 +/- 5.2% to 10.3 +/- 3.9%, p <0.05). Hibernating myocardial segments exhibited significantly higher unipolar voltages and late thallium uptake at rest at baseline. Receiver-operator characteristic analysis showed a mean unipolar voltage of 9.0 mV (predictive accuracy 0.708, common sensitivity and specificity 72%) in the region of interest for prediction of functional recovery. In conclusion, for characterizing the hibernating myocardium within viable segments, NOGA endocardial mapping offers on-line guidance for percutaneous coronary and noncoronary myocardial revascularization.
