Time course of functional recovery after revascularization of hibernating myocardium: a contrast-enhanced cardiovascular magnetic resonance study.
OBJECTIVE
We sought to evaluate the relation between long-term functional outcome after revascularization in patients with chronic ischaemic left ventricular (LV) dysfunction and baseline extent of myocardial fibrosis.


RESULTS
Thirty-five patients underwent cine and delayed contrast-enhanced cardiovascular magnetic resonance (deCMR) for the quantitative assessment of regional and global LV functions and segmental extent of hyperenhancement (SEH). Function was assessed 1 month before and 3, 6, and 24 +/- 12 months after revascularization, and temporal changes were related to baseline extent of hyperenhancement. The likelihood of functional improvement was inversely related to the SEH during the entire follow-up: at the end of the study period, segments with 1-25, 26-50, 51-75, and 76-100% SEH were 2, 5, 11, and 86 times, respectively, less likely to have functional improvement than segments without hyperenhancement (multilevel analysis, P < 0.001). Although improvement continued over the whole study period in all SEH groups, the time course was significantly more delayed in segments with more extensive hyperenhancement at baseline (multilevel analysis, P < 0.001).


CONCLUSIONS
In patients with chronic ischaemic LV dysfunction, improvement of dysfunctional but viable myocardium can be considerably delayed. Both the likelihood and the time course of long-term functional improvement are related to the baseline amount of scar, as visualized by deCMR.
Department of Cardiology, VU University Medical Centre, De Boelelaan 1117, Amsterdam HV 1081, The Netherlands. o.bondarenko@vumc.nl
Olga
O
Bondarenko
Aernout M
AM
Beek
Jos W R
JW
Twisk
Cees A
CA
Visser
Albert C
AC
van Rossum
D002908:Chronic Disease; D002921:Cicatrix / Q000175:diagnosis; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000592:standards*; D017682:Myocardial Stunning / Q000601:surgery*; D020127:Recovery of Function / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery
D003287:Contrast Media; D019786:Gadolinium DTPA