[Synchronized coronary vein retroperfusion for identification of myocardium with chronic ischemic disorders of wall movement ("hibernating myocardium")].
ECG-synchronized retroperfusion (SRP) via the coronary sinus has been recently demonstrated to efficiently deliver arterial blood to ischemic myocardium in an experimental setting and during PTCA. To assess the potential of SRP for identifying hibernating myocardium by improved contractile function resulting from retrograde delivery of oxygen, 10 patients (M/F = 9/1; age 56 +/- 9 years) with ischemic wall motion abnormalities, but, according to ECG-criteria, no transmural infarction in the territory of a totally occluded LAD, underwent 30 min of SRP at a flow rate of 145-250 ml/min prior to mechanical recanalization. Serial digital ventriculograms were obtained before, after 30 min of SRP and, finally, after successful PTCA at follow-up of 28 +/- 4 days.


RESULTS
Wall motion analysis revealed improved global and regional contractile function in seven of 10 patients, which was maintained after successful PTCA. Continuous SRP over 30 min resulted in an improvement of global and segmental systolic function. Left ventricular ejection fraction (LVEF) increased from 53 +/- 8% to 58 +/- 5% with 30 min of SRP (p < 0.03) and significant improvement in regional function was detected in the anterobasal, apical and inferior segment of the left ventricular circumference (p < 0.05).


CONCLUSIONS
An improved contractile response to retrograde delivery of oxygen by SRP appears to document the reversibility of myocardial hibernation. Thus, ECG-synchronized SRP via the coronary sinus has the potential to unmask viable myocardium likely to completely recover from contractile dysfunction after successful antegrade recanalization. Moreover, continuous SRP procedure over 30 min was safe and had no hazardous side-effects.
Nienaber
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CA
Abteilung für Kardiologie, Medizinischen Klinik und Poliklinik, Universitätskrankenhaus Eppendorf, Hamburg.
Abend
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Rehders
T C
TC
Stiel
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GM
Lund
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G
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D017023:Coronary Angiography / Q000295:instrumentation; D003326:Coronary Circulation / Q000502:physiology*; D005260:Female; D015637:Gated Blood-Pool Imaging; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000503:physiopathology; D015425:Myocardial Reperfusion / Q000295:instrumentation; D016277:Ventricular Function, Left / Q000502:physiology