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[Chronic ischemic heart failure. Revascularization improves survival among patients with hibernating myocardium]
Paw Chr Holdgaard1, Søren Steen Nielsen, Henrik Wiggers
1Arhus Universitetshospital, Skejby, Afdelingen for Klinisk Fysiologi, Arhus N. paw@dadlnet.dk
Insights
Patients with hibernating myocardium (HIB) who received revascularization showed improved survival rates. Untreated HIB significantly increased the risk of sudden cardiac death, highlighting the importance of nuclear imaging for treatment decisions.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- Ischemic heart failure patients with hibernating myocardium (HIB) can benefit from revascularization.
- Nuclear imaging techniques are crucial for identifying these patients.
- This study evaluates imaging results in relation to treatment and mortality.
Purpose of the Study:
- To assess the outcomes of nuclear imaging procedures in patients evaluated for HIB.
- To correlate imaging findings with treatment choices and causes of death.
- To determine the prognostic value of identifying hibernating myocardium.
Main Methods:
- Retrospective analysis of 51 patients over 2 years.
- Utilized myocardial perfusion imaging (99mTc-sestamibi) and glucose metabolism imaging (18F-FDG PET).
- Reviewed medical records and death certificates.
Main Results:
- Included 50 patients; revascularized HIB patients had significantly lower 1-year mortality (6% vs. 33%, p=0.004).
- Patients with HIB who did not undergo revascularization faced a higher risk of sudden death (p=0.003).
- Nuclear imaging effectively identified patients with hibernating myocardium.
Conclusions:
- Nuclear imaging is valuable for selecting heart failure patients for revascularization.
- Revascularization improves survival in patients with hibernating myocardium.
- Further prospective studies are needed to mitigate potential selection bias from retrospective analyses.
Introduction:
Patients with ischemic heart failure and reversible dysfunctional myocardium (Hibernating myocardium, HIB) can benefit from revascularization. These patients can be selected with nuclear methods. The purpose of this study was to describe the results of the imaging procedures in patients tested for HIB and relate the results to the choice of treatment and cause of death.
Materials And Methods:
During a 2-year period 51 patients were referred to determine the amount of HIB. This can be determined with blood flow and metabolic imaging of the heart. Resting-myocardial perfusion imaging was performed with 99mTc-sestamibi and glucose metabolism was visualized with 18F-fluorodeoxyglucose (18F-FDG) gamma camera PET. Medical records and death certificate were reviewed retrospectively.
Results:
50 patients were included. We found an increased survival among patients with HIB who underwent revascularization (1 year mortality 6% vs. 33%, p = 0,004). Patients with HIB who did not undergo revascularization had an increased risk of sudden death. (5/15 patients vs. 0/35 patients, p = 0,003).
Conclusion:
Despite a simplified method we find the same increased mortality among medically-treated patients with HIB as in earlier studies. This and earlier studies are all retrospective with the risk of selection bias. Prospective studies are underway. Nuclear imaging is useful in evaluating patients with heart failure before revascularization.
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