Contractile Reserve in Segments With Nontransmural Infarction in Chronic Dysfunctional Myocardium Using Low-Dose Dobutamine CMR
Objectives This study sought to quantify contractile reserve of chronic dysfunctional myocardium, in particular in segments with intermediate transmural extent of infarction (TEI), using low-dose dobutamine cardiac magnetic resonance (CMR) in patients with a chronic total coronary occlusion (CTO). B...
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| Veröffentlicht in: | JACC. Cardiovascular imaging 2010-06, Vol.3 (6), p.614-622 |
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| creator | Kirschbaum, Sharon W., MD Rossi, Alexia, MD van Domburg, Ron T., PhD Gruszczynska, Katerina, MD Krestin, Gabriel P., MD, PhD Serruys, Patrick W., MD, PhD Duncker, Dirk J., MD, PhD de Feyter, Pim J., MD, PhD van Geuns, Robert-Jan M., MD, PhD |
| description | Objectives This study sought to quantify contractile reserve of chronic dysfunctional myocardium, in particular in segments with intermediate transmural extent of infarction (TEI), using low-dose dobutamine cardiac magnetic resonance (CMR) in patients with a chronic total coronary occlusion (CTO). Background Recovery of dysfunctional segments with intermediate TEI after percutaneous coronary intervention is variable and difficult to predict, and may be related to contractility of the unenhanced rim. Methods Fifty-one patients (mean age 60 ± 9 years, 76% male) with a CTO underwent CMR at baseline and 35 patients underwent CMR at follow-up to quantify segmental wall thickening (SWT) at rest during 5 and 10 μg/kg/min dobutamine, and at follow-up. Delayed-enhancement CMR was performed to quantify TEI. Dysfunctional segments were stratified according to TEI, end-diastolic wall thickness (EDWT), or unenhanced rim thickness, and SWT was quantified. Segments with an intermediate TEI (25% to 75%) were further stratified according to baseline SWT of the unenhanced rim (SWTUR ) (45%), and SWT was quantified. For each parameter, odds ratio (OR) and diagnostic performance for the prediction of contractile reserve were calculated. Results Significant contractile reserve was present in dysfunctional segments with EDWT >6 mm, unenhanced rim thickness >3 mm, or TEI of |
| doi_str_mv | 10.1016/j.jcmg.2010.03.007 |
| format | Article |
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Background Recovery of dysfunctional segments with intermediate TEI after percutaneous coronary intervention is variable and difficult to predict, and may be related to contractility of the unenhanced rim. Methods Fifty-one patients (mean age 60 ± 9 years, 76% male) with a CTO underwent CMR at baseline and 35 patients underwent CMR at follow-up to quantify segmental wall thickening (SWT) at rest during 5 and 10 μg/kg/min dobutamine, and at follow-up. Delayed-enhancement CMR was performed to quantify TEI. Dysfunctional segments were stratified according to TEI, end-diastolic wall thickness (EDWT), or unenhanced rim thickness, and SWT was quantified. Segments with an intermediate TEI (25% to 75%) were further stratified according to baseline SWT of the unenhanced rim (SWTUR ) (<45% and >45%), and SWT was quantified. For each parameter, odds ratio (OR) and diagnostic performance for the prediction of contractile reserve were calculated. Results Significant contractile reserve was present in dysfunctional segments with EDWT >6 mm, unenhanced rim thickness >3 mm, or TEI of <25%; only TEI had significant relation with contractile reserve (OR: 0.98; 95% confidence interval [CI]: 0.96 to 0.99; p = 0.02). In segments with intermediate TEI (n = 58), mean SWT did not improve significantly. However, segments with SWTUR <45% showed contractile reserve and improved at follow-up, whereas segments with SWTUR >45% were unchanged. SWTUR had a significant relation with contractile reserve (OR: 0.98; 95% CI: 0.97 to 0.99; p = 0.02). Conclusions CMR quantification of transmurality of infarcted myocardium allows the assessment of the potential of dysfunctional segments to improve in function during dobutamine of most segments. However, in segments with intermediate TEI, measurement of baseline contractility of the epicardial rim better identifies which segments maintain contractile reserve.</description><identifier>ISSN: 1936-878X</identifier><identifier>EISSN: 1876-7591</identifier><identifier>DOI: 10.1016/j.jcmg.2010.03.007</identifier><identifier>PMID: 20541717</identifier><language>eng</language><publisher>United States</publisher><subject>Aged ; Angioplasty, Balloon, Coronary ; Cardiovascular ; Contrast Media ; Coronary Occlusion - complications ; Coronary Occlusion - diagnosis ; Coronary Occlusion - physiopathology ; Coronary Occlusion - therapy ; Dobutamine - administration & dosage ; Female ; Gadolinium DTPA ; Hemodynamics ; Humans ; Infusions, Intravenous ; Logistic Models ; Magnetic Resonance Imaging, Cine ; Male ; Middle Aged ; Myocardial Contraction ; Myocardial Infarction - diagnosis ; Myocardial Infarction - etiology ; Myocardial Infarction - physiopathology ; Myocardial Infarction - therapy ; Myocardium - pathology ; Netherlands ; Odds Ratio ; Predictive Value of Tests ; Prospective Studies ; Recovery of Function ; Time Factors ; Treatment Outcome</subject><ispartof>JACC. Cardiovascular imaging, 2010-06, Vol.3 (6), p.614-622</ispartof><rights>American College of Cardiology Foundation</rights><rights>Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c401t-f2df9527f9b74979fdf44a4177a481320786bd21b650fe5a6104937d60789f423</citedby><cites>FETCH-LOGICAL-c401t-f2df9527f9b74979fdf44a4177a481320786bd21b650fe5a6104937d60789f423</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20541717$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kirschbaum, Sharon W., MD</creatorcontrib><creatorcontrib>Rossi, Alexia, MD</creatorcontrib><creatorcontrib>van Domburg, Ron T., PhD</creatorcontrib><creatorcontrib>Gruszczynska, Katerina, MD</creatorcontrib><creatorcontrib>Krestin, Gabriel P., MD, PhD</creatorcontrib><creatorcontrib>Serruys, Patrick W., MD, PhD</creatorcontrib><creatorcontrib>Duncker, Dirk J., MD, PhD</creatorcontrib><creatorcontrib>de Feyter, Pim J., MD, PhD</creatorcontrib><creatorcontrib>van Geuns, Robert-Jan M., MD, PhD</creatorcontrib><title>Contractile Reserve in Segments With Nontransmural Infarction in Chronic Dysfunctional Myocardium Using Low-Dose Dobutamine CMR</title><title>JACC. Cardiovascular imaging</title><addtitle>JACC Cardiovasc Imaging</addtitle><description>Objectives This study sought to quantify contractile reserve of chronic dysfunctional myocardium, in particular in segments with intermediate transmural extent of infarction (TEI), using low-dose dobutamine cardiac magnetic resonance (CMR) in patients with a chronic total coronary occlusion (CTO). Background Recovery of dysfunctional segments with intermediate TEI after percutaneous coronary intervention is variable and difficult to predict, and may be related to contractility of the unenhanced rim. Methods Fifty-one patients (mean age 60 ± 9 years, 76% male) with a CTO underwent CMR at baseline and 35 patients underwent CMR at follow-up to quantify segmental wall thickening (SWT) at rest during 5 and 10 μg/kg/min dobutamine, and at follow-up. Delayed-enhancement CMR was performed to quantify TEI. Dysfunctional segments were stratified according to TEI, end-diastolic wall thickness (EDWT), or unenhanced rim thickness, and SWT was quantified. Segments with an intermediate TEI (25% to 75%) were further stratified according to baseline SWT of the unenhanced rim (SWTUR ) (<45% and >45%), and SWT was quantified. For each parameter, odds ratio (OR) and diagnostic performance for the prediction of contractile reserve were calculated. Results Significant contractile reserve was present in dysfunctional segments with EDWT >6 mm, unenhanced rim thickness >3 mm, or TEI of <25%; only TEI had significant relation with contractile reserve (OR: 0.98; 95% confidence interval [CI]: 0.96 to 0.99; p = 0.02). In segments with intermediate TEI (n = 58), mean SWT did not improve significantly. However, segments with SWTUR <45% showed contractile reserve and improved at follow-up, whereas segments with SWTUR >45% were unchanged. SWTUR had a significant relation with contractile reserve (OR: 0.98; 95% CI: 0.97 to 0.99; p = 0.02). Conclusions CMR quantification of transmurality of infarcted myocardium allows the assessment of the potential of dysfunctional segments to improve in function during dobutamine of most segments. However, in segments with intermediate TEI, measurement of baseline contractility of the epicardial rim better identifies which segments maintain contractile reserve.</description><subject>Aged</subject><subject>Angioplasty, Balloon, Coronary</subject><subject>Cardiovascular</subject><subject>Contrast Media</subject><subject>Coronary Occlusion - complications</subject><subject>Coronary Occlusion - diagnosis</subject><subject>Coronary Occlusion - physiopathology</subject><subject>Coronary Occlusion - therapy</subject><subject>Dobutamine - administration & dosage</subject><subject>Female</subject><subject>Gadolinium DTPA</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Infusions, Intravenous</subject><subject>Logistic Models</subject><subject>Magnetic Resonance Imaging, Cine</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial Contraction</subject><subject>Myocardial Infarction - diagnosis</subject><subject>Myocardial Infarction - etiology</subject><subject>Myocardial Infarction - physiopathology</subject><subject>Myocardial Infarction - therapy</subject><subject>Myocardium - pathology</subject><subject>Netherlands</subject><subject>Odds Ratio</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Recovery of Function</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1936-878X</issn><issn>1876-7591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kU1v1DAQQCMEoqXwBzgg3zhlGTuOnVyQUJaPSluQWiq4WU4y3jokdmsnRXvir-N0C77YGr-Z0bzJstcUNhSoeDdshm7abxikABQbAPkkO6WVFLksa_o0vetC5JWsfp5kL2IcAAQILp9nJwxKTiWVp9mfxrs56G62I5JLjBjukVhHrnA_oZsj-WHnG_L1AXJxWoIeybkzOqQM71ayuQne2Y5sD9Es7iGcmIuD73To7TKR62jdnuz873zrI5Ktb5dZT9YhaS4uX2bPjB4jvnq8z7LrTx-_N1_y3bfP582HXd5xoHNuWG_qkklTt5LXsja94VynGaTmFS0YyEq0PaOtKMFgqQUFXheyF-mjNpwVZ9nbY93b4O8WjLOabOxwHLVDv0Qli3QSLRLJjmQXfIwBjboNdtLhoCio1bsa1Opdrd4VFCp5T0lvHssv7YT9_5R_ohPw_ghgGvLeYlDdaJM2Pf7CA8bBLyFpi4qqyBSoq3V16-YoAKRGdfEX3zCVeQ</recordid><startdate>20100601</startdate><enddate>20100601</enddate><creator>Kirschbaum, Sharon W., MD</creator><creator>Rossi, Alexia, MD</creator><creator>van Domburg, Ron T., PhD</creator><creator>Gruszczynska, Katerina, MD</creator><creator>Krestin, Gabriel P., MD, PhD</creator><creator>Serruys, Patrick W., MD, PhD</creator><creator>Duncker, Dirk J., MD, PhD</creator><creator>de Feyter, Pim J., MD, PhD</creator><creator>van Geuns, Robert-Jan M., MD, PhD</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20100601</creationdate><title>Contractile Reserve in Segments With Nontransmural Infarction in Chronic Dysfunctional Myocardium Using Low-Dose Dobutamine CMR</title><author>Kirschbaum, Sharon W., MD ; Rossi, Alexia, MD ; van Domburg, Ron T., PhD ; Gruszczynska, Katerina, MD ; Krestin, Gabriel P., MD, PhD ; Serruys, Patrick W., MD, PhD ; Duncker, Dirk J., MD, PhD ; de Feyter, Pim J., MD, PhD ; van Geuns, Robert-Jan M., MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c401t-f2df9527f9b74979fdf44a4177a481320786bd21b650fe5a6104937d60789f423</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Aged</topic><topic>Angioplasty, Balloon, Coronary</topic><topic>Cardiovascular</topic><topic>Contrast Media</topic><topic>Coronary Occlusion - complications</topic><topic>Coronary Occlusion - diagnosis</topic><topic>Coronary Occlusion - physiopathology</topic><topic>Coronary Occlusion - therapy</topic><topic>Dobutamine - administration & dosage</topic><topic>Female</topic><topic>Gadolinium DTPA</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Infusions, Intravenous</topic><topic>Logistic Models</topic><topic>Magnetic Resonance Imaging, Cine</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myocardial Contraction</topic><topic>Myocardial Infarction - diagnosis</topic><topic>Myocardial Infarction - etiology</topic><topic>Myocardial Infarction - physiopathology</topic><topic>Myocardial Infarction - therapy</topic><topic>Myocardium - pathology</topic><topic>Netherlands</topic><topic>Odds Ratio</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Recovery of Function</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kirschbaum, Sharon W., MD</creatorcontrib><creatorcontrib>Rossi, Alexia, MD</creatorcontrib><creatorcontrib>van Domburg, Ron T., PhD</creatorcontrib><creatorcontrib>Gruszczynska, Katerina, MD</creatorcontrib><creatorcontrib>Krestin, Gabriel P., MD, PhD</creatorcontrib><creatorcontrib>Serruys, Patrick W., MD, PhD</creatorcontrib><creatorcontrib>Duncker, Dirk J., MD, PhD</creatorcontrib><creatorcontrib>de Feyter, Pim J., MD, PhD</creatorcontrib><creatorcontrib>van Geuns, Robert-Jan M., MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>JACC. Cardiovascular imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kirschbaum, Sharon W., MD</au><au>Rossi, Alexia, MD</au><au>van Domburg, Ron T., PhD</au><au>Gruszczynska, Katerina, MD</au><au>Krestin, Gabriel P., MD, PhD</au><au>Serruys, Patrick W., MD, PhD</au><au>Duncker, Dirk J., MD, PhD</au><au>de Feyter, Pim J., MD, PhD</au><au>van Geuns, Robert-Jan M., MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Contractile Reserve in Segments With Nontransmural Infarction in Chronic Dysfunctional Myocardium Using Low-Dose Dobutamine CMR</atitle><jtitle>JACC. Cardiovascular imaging</jtitle><addtitle>JACC Cardiovasc Imaging</addtitle><date>2010-06-01</date><risdate>2010</risdate><volume>3</volume><issue>6</issue><spage>614</spage><epage>622</epage><pages>614-622</pages><issn>1936-878X</issn><eissn>1876-7591</eissn><abstract>Objectives This study sought to quantify contractile reserve of chronic dysfunctional myocardium, in particular in segments with intermediate transmural extent of infarction (TEI), using low-dose dobutamine cardiac magnetic resonance (CMR) in patients with a chronic total coronary occlusion (CTO). Background Recovery of dysfunctional segments with intermediate TEI after percutaneous coronary intervention is variable and difficult to predict, and may be related to contractility of the unenhanced rim. Methods Fifty-one patients (mean age 60 ± 9 years, 76% male) with a CTO underwent CMR at baseline and 35 patients underwent CMR at follow-up to quantify segmental wall thickening (SWT) at rest during 5 and 10 μg/kg/min dobutamine, and at follow-up. Delayed-enhancement CMR was performed to quantify TEI. Dysfunctional segments were stratified according to TEI, end-diastolic wall thickness (EDWT), or unenhanced rim thickness, and SWT was quantified. Segments with an intermediate TEI (25% to 75%) were further stratified according to baseline SWT of the unenhanced rim (SWTUR ) (<45% and >45%), and SWT was quantified. For each parameter, odds ratio (OR) and diagnostic performance for the prediction of contractile reserve were calculated. Results Significant contractile reserve was present in dysfunctional segments with EDWT >6 mm, unenhanced rim thickness >3 mm, or TEI of <25%; only TEI had significant relation with contractile reserve (OR: 0.98; 95% confidence interval [CI]: 0.96 to 0.99; p = 0.02). In segments with intermediate TEI (n = 58), mean SWT did not improve significantly. However, segments with SWTUR <45% showed contractile reserve and improved at follow-up, whereas segments with SWTUR >45% were unchanged. SWTUR had a significant relation with contractile reserve (OR: 0.98; 95% CI: 0.97 to 0.99; p = 0.02). Conclusions CMR quantification of transmurality of infarcted myocardium allows the assessment of the potential of dysfunctional segments to improve in function during dobutamine of most segments. However, in segments with intermediate TEI, measurement of baseline contractility of the epicardial rim better identifies which segments maintain contractile reserve.</abstract><cop>United States</cop><pmid>20541717</pmid><doi>10.1016/j.jcmg.2010.03.007</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Angioplasty, Balloon, Coronary Cardiovascular Contrast Media Coronary Occlusion - complications Coronary Occlusion - diagnosis Coronary Occlusion - physiopathology Coronary Occlusion - therapy Dobutamine - administration & dosage Female Gadolinium DTPA Hemodynamics Humans Infusions, Intravenous Logistic Models Magnetic Resonance Imaging, Cine Male Middle Aged Myocardial Contraction Myocardial Infarction - diagnosis Myocardial Infarction - etiology Myocardial Infarction - physiopathology Myocardial Infarction - therapy Myocardium - pathology Netherlands Odds Ratio Predictive Value of Tests Prospective Studies Recovery of Function Time Factors Treatment Outcome |
| title | Contractile Reserve in Segments With Nontransmural Infarction in Chronic Dysfunctional Myocardium Using Low-Dose Dobutamine CMR |
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