Intra-procedural determination of viability by myocardial deformation imaging: a randomized prospective study in the cardiac catheter laboratory.
BACKGROUND
The benefit of revascularization for functional recovery depends on the presence of viable myocardial tissue.


OBJECTIVE
Myocardial deformation imaging allows determination of myocardial viability.


METHODS
In a first approach, we assessed the optimal cutoff value to determine preserved viability by layer-specific echocardiographic myocardial deformation imaging at rest and low-dose dobutamine (DSE) echocardiography: regional endocardial circumferential strain (eCS) <-19% at rest was as accurate as eCS at DSE. In a main study, 123 patients (66% men, age 59 ± 6 years) with relevant coronary stenoses and corresponding severe regional myocardial dysfunction were included and randomized in 2 groups after coronary angiography: group A: intra-procedural myocardial deformation imaging in the cardiac catheter laboratory (CLab), determination of myocardial viability by regional eCS <-19%, in case of positive viability immediate coronary intervention in the same session. Group B: two-step determination of myocardial viability by cardiovascular magnetic resonance (CMR), in case of positive viability coronary intervention. After 18 months follow-up an analysis of the endpoints regarding cardiovascular events, left ventricular (LV) function, and comparison of cost was performed.


RESULTS
Group A (N = 61) and group B (N = 62) showed no differences concerning localization of the coronary stenosis, comorbidities, or medical therapy. Cardiovascular events at 18-month follow-up were as follows: group A 13% (N = 10) vs. group B 14% (N = 9, p = 0.288); improvement of LV function: group A: +7 ± 2% vs. group B: +7 ± 3%, p = 0.963; costs: group A: 3096 Dollar vs. group B: 6043 Dollar, p < 0.001.


CONCLUSIONS
Intra-procedural determination of myocardial viability by myocardial deformation imaging in the CLab is feasible, safe, and cost effective and may become an emerging alternative to the current practice of two-stage viability diagnostics.
Department of Cardiology, RWTH Aachen University, Aachen, Germany.
Alexander
A
Schuh
Department of Cardiology, RWTH Aachen University, Aachen, Germany.
Vadim
V
Karayusuf
Department of Cardiology, RWTH Aachen University, Aachen, Germany.
Ertunc
E
Altiok
Department of Cardiology, RWTH Aachen University, Aachen, Germany.
Sandra
S
Hamada
Department of Cardiology, RWTH Aachen University, Aachen, Germany.
Jörg
J
Schröder
Department of Medical Statistics, RWTH Aachen University, Aachen, Germany.
Andras
A
Keszei
Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany.
Malte
M
Kelm
Medical Engineering, Helmholtz Institute for Biomedical Engineering, Aachen, Germany.
Matias
M
de la Fuente
Department of Cardiology, RWTH Aachen University, Aachen, Germany.
Michael
M
Frick
Medical Engineering, Helmholtz Institute for Biomedical Engineering, Aachen, Germany.
Klaus
K
Radermacher
Department of Cardiology, RWTH Aachen University, Aachen, Germany.
Nikolaus
N
Marx
Department of Cardiology, RWTH Aachen University, Aachen, Germany. mibecker@ukaachen.de.
Michael
M
Becker
D006328:Cardiac Catheterization / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D009204:Myocardial Revascularization / Q000379:methods*; D010865:Pilot Projects; D011446:Prospective Studies; D015203:Reproducibility of Results; D016277:Ventricular Function, Left / Q000502:physiology*
Coronary intervention; Intra-procedural; Myocardial deformation imaging; Myocardial viability