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Intra-procedural determination of viability by myocardial deformation imaging: a randomized prospective study in the cardiac catheter laboratory

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An Erratum to this article was published on 02 June 2017

This article has been updated

Abstract

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.

Conclusion

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.

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  • 02 June 2017

    An erratum to this article has been published.

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Acknowledgements

MB designed the study and managed research process; MB, AS, and VK chaired data acquisition and analysis and interpretation of results; and VK and MB wrote the report. MB, AS, and VK had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. Data were analyzed by SH and JS (DSE) and EA (CMR). MDF developed the medical-technical approach of image fusion. AK contributed to statistical interpretation of results. MK and NM contributed to data analysis and interpretation and reviewed the report. NM and SH contributed to the writing of the report.

Funding

The study was granted by the German Research Foundation (BE 4388/1–1, DE 1705/1–1).

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    Authors and Affiliations

    1. Department of Cardiology, RWTH Aachen University, Aachen, Germany

      Alexander Schuh, Vadim Karayusuf, Ertunc Altiok, Sandra Hamada, Jörg Schröder, Michael Frick, Nikolaus Marx & Michael Becker

    2. Department of Medical Statistics, RWTH Aachen University, Aachen, Germany

      Andras Keszei

    3. Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany

      Malte Kelm

    4. Medical Engineering, Helmholtz Institute for Biomedical Engineering, Aachen, Germany

      Matias de la Fuente & Klaus Radermacher

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    1. Alexander Schuh
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    Correspondence to Michael Becker.

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    Alexander Schuh and Vadim Karayusuf have contributed equally to this work.

    An erratum to this article is available at https://doi.org/10.1007/s00392-017-1125-y.

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    Schuh, A., Karayusuf, V., Altiok, E. et al. Intra-procedural determination of viability by myocardial deformation imaging: a randomized prospective study in the cardiac catheter laboratory. Clin Res Cardiol 106, 629–644 (2017). https://doi.org/10.1007/s00392-017-1099-9

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