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Correlation of myocardial histologic changes in hibernating myocardium with dobutamine stress echocardiographic
T Hennessy1, P Diamond, B Holligan
1Department of Cardiology, Mater Misericordiae Hospital, Dublin, Ireland.
Insights
Dobutamine stress echocardiography (DSE) accurately identifies hibernating myocardium, a condition where heart muscle has reduced function but can recover. This finding correlates with less fibrosis and more nucleated cells in myocardial tissue.
Area of Science:
- Cardiology
- Cardiac Surgery
- Histopathology
Background:
- Hibernating myocardium is characterized by impaired contractility despite preserved viability.
- Dobutamine stress echocardiography (DSE) is a non-invasive tool to assess myocardial viability.
- Histologic examination provides direct evidence of myocardial tissue characteristics.
Purpose of the Study:
- To correlate histologic findings of hibernating myocardium with DSE results.
- To evaluate the sensitivity and specificity of DSE in detecting myocardial hibernation.
- To investigate the relationship between fibrosis, nucleated cells, and cytoplasmic clearance in hibernating segments.
Main Methods:
- Eight patients with coronary artery disease underwent DSE.
- 56 myocardial segments were analyzed based on DSE findings.
- Two transmural biopsy specimens were obtained from the left ventricle anterior wall during coronary artery bypass grafting.
Main Results:
- Segments with inotropic reserve and improved wall motion post-revascularization showed significantly less fibrosis (p < 0.05).
- DSE demonstrated 100% sensitivity and 62% specificity for detecting hibernating myocardial segments.
- Fibrosis was inversely correlated with nucleated cells (r = 0.66, p < 0.01) and directly correlated with cytoplasmic clearance (r = 0.76, p < 0.01).
Conclusions:
- DSE-induced inotropic response is a reliable indicator of hibernating myocardium.
- Histologic analysis supports DSE findings, with reduced fibrosis in viable segments.
- The study validates DSE as a method for identifying hibernating myocardium.
Objective:
The objective of this study was to correlate histologic changes in hibernating myocardium with dobutamine stress echocardiography (DSE).
Methods:
Patients (n = 8) with anterior regional wall motion abnormalities in the seven echocardiographic segments representing the territory supplied by a significantly stenosed left anterior descending coronary artery had preoperative DSE performed (yielding 56 segments for analysis). Two transmural biopsy specimens were taken from the anterior wall of the left ventricle during coronary artery bypass grafting.
Results:
Morphometric histologic analysis of biopsy specimens showed significantly less fibrosis in segments demonstrating inotropic reserve (p < 0.05) and significantly less fibrosis in segments demonstrating improvement in wall motion on echocardiography 3 months after revascularization (p < 0.05). DSE had a sensitivity of 100% and a specificity of 62% for detection of hibernating myocardial segments. Percent fibrosis was inversely correlated with percent nucleated cells (r = 0.66, p < 0.01) and directly correlated with cytoplasmic clearance (r = 0.76, p < 0.01).
Conclusion:
Inotropic response during DSE correlates with histologic evidence of hibernating myocardium.