Perfusion-Metabolic Myocardial Scintigraphy in Prognosis of Left Ventricular Remodeling After Complex Surgical Treatment of Ischemic Cardiomyopathy

Purpose. To study capabilities of perfusion-metabolic myocardial scintigraphy for prediction of the left ventricular (LV) reverse remodeling after comprehensive surgical treatment of ischemic cardiomyopathy (ICMP). Methods. Жє study included ICMP patients aged 56±7 years (n=32) who underwent surgical correction of LV dysfunction (myocardial revascularization, LV reconstruction, and mitral valve restoration). Inclusion criteria were significant coronary artery disease; myocardial infarction; New York Heart Association (NYHA) class III-IV heart failure; LV ejection fraction (EF) ≤45%; LV end-systolic index (ESI) >60 mL/m²; and LV akinesia or dyskinesia according to echocardiography. Before surgery all patients were subj ected to scintigraphy with^99mTc-MIBI (to assess perfusion) and with¹²³I-BMIPP (to assess myocardial metabolism). Scintigraphy results were expressed as median and lower; upper quartile (Me [lQj hQ]). Ue clinical status and ventricular volume indicators were evaluated before surgery, in the early post-operative period (up to 4 weeks), and in the late post-operative period (12 months). Results. At 12 months after intervention patients were divided into two groups: group 1 comprised patients (n=18) with beneficial outcome of the operation that stopped LV remodeling (ESI decreased, remained unchanged, or increased by <15% compared with early postoperative period. Group 2 comprised patients (n=14) in whom LV remodeling progressed despite successful surgery (ESI increased ≥15% compared with early postoperative period). Groups did not significantly differ by preoperative echocardiography data and clinical status. Significant differences were found in the following scintigraphic parameters: metabolic defect on delayed images (26.5% [20.6%; 32.4%] vs. 38.2% [16.2%; 44.1%], p=0.02), and perfusion-metabolic mismatch (PMM) on early (5.9% [- 5.9%; 7.4%] vs. 1.5% [- 7.4%, 1.5%], p=0.02,) and on delayed (14.7% [5.9%; 27.9%] vs. 4.4% [2.9%; 7.4%], p <0.0001) scans in groups 1 and 2, respectively. PMM on delayed scans had the largest area under the ROC-curve (AUC=0.778, p<0.0001). PMM cutoff value of 12% allowed to predict the efficacy of comprehensive surgical treatment for LV dysfunction with sensitivity and specificity of 100 and 56%, respectively. Conclusion. In patients with ICMP results of myocardial perfusion-metabolic scintigraphy can be used in prognostication of reverse cardiac remodeling in the postoperative period.

ишемическая кардиомиопатия, сцинтиграфия миокарда, повторное ремоделирование, хирургическая реконструкция левого желудочка, ischemic cardiomyopathy, myocardial scintigraphy, reverse remodeling, surgical ventricular restoration

1. Агеев Ф. Т., Даниелян М. О., Мареев В. Ю., Беленков Ю. Н. Больные с хронической сердечной недостаточностью в российской амбулаторной практике: особенности контингента, диагностики и лечения (по материалам исследования ЭПОХА-О-ХСН). Сердечная недостаточность 2004; 5 (l):4-7

2. Burch G.E., Giles T.D., Colcolough H.L. Ischemic cardiomyopathy. Am Heart J. 1970;79 (3):291-292.

3. Шулутко Б.И. Справочник терапевта. 4-е изд. СПб.: ЭлбиСПб 2008; 309c

4. Felker G.M., Shaw L.K., O' Connor Ch.M. A standardized definition of ischemic cardiomypathy for use in clinical research. JACC 2002;39:210-218.

5. Maisch B. Ventricular remodeling. Cardiology 1996;87 (1):2-10.

6. Jackson B., Gorman J., Moainie S., et al. Extension of borderzone myocardium in postinfarction dilated cardiomyopathy. JACC 2002;40:1160-1167.

7. Braunwald E., Bristow M.R. Congestive heart failure: fifty years of progress. Circulation 2000;102 (20):14-13.

8. O'Neill J.O., Starling R.C. Surgical Remodeling in Ischemic Cardiomyopathy. Curr Treat Options Cardiovasc Med 2003;5 (4):311-319.

9. Moreira L. F., Stolf N. A., de Lourdes Higuchi M. et al. Current perspectives of partial left ventriculectomy in the treatment of dilated cardiomyopathy. Eur J. Cardiothorac Surg 2001;19:54-60.

10. Soo E. N., Ascione R., Wilde P., Angelini G. D. Eight years survival after partial left ventriculectomy. Eur J. Cardiothorac Surg 2005;27:724-725.

11. Menicanti L., Di Donato M. The Dor procedure: What has changed after fifteen years of clinical practice? J. Thorac Cardiovasc Surg 2002;124:886-870.

12. Iskandrian A.S., Hakki A.H. Radionuclide evaluation of exercise left ventricular performance in patients with coronary artery disease. Am Heart J. 1985;110 (4):851-856.

13. Hambye A.S., Dobbeleir A.A., Vervaet A.M. et al. BMIPP imaging to improve the value of sestamibi scintigraphy for predicting functional outcome in severe chronic ischemic left ventricular dysfunction. J. Nucl Med 1999;40 (9):1468-1466.

14. Гуля М. О., Лишманов Ю. Б., Завадовский К. В., Лебедев Д. И. Cостояние метаболизма жирных кислот в миокарде левого желудочка и прогноз эффективности кардиоресинхронизирующей терапии у пациентов с дилатационной кардиомиопатией. Российский кардиологический журнал 2014;9 (113):61-67

15. Zavadovsky K.V., Gulya M.O., Lishmanov Y.B., Lebedev D.I. Perfusion and metabolic scintigraphy with 123I-BMIPP in prognosis of cardiac resynchronization therapy in patients with dilated cardiomyopathy. Ann Nucl Med 2016;30 (2).

16. Лишманов Ю., Ефимова И., Чернов В. и др. Сцинтиграфия как инструмент диагностики, прогнозирования и мониторинга лечения болезней сердца. Сибирский медицинский журнал (г. Томск) 2007;22 (3):74-77.

17. Hesse B., Tägil K., Cuocolo A. et al. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J. Nucl Med Mol Imaging 2005;32 (7):855-897.

18. Di Carli M.F., Davidson M., Little R. et al. Value of metabolic imaging with positron emission tomography for evaluating prognosis in patients with coronary artery disease and left ventricular dysfunction. Am J. Cardiol 1994;73:527-523.

19. Kolh P., Windecker S., Alfonso F. et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution ofthe European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J. Cardiothorac Surg 2014;46 (4):517-512.

20. Michler R.E., Rouleau J.L., Al-Khalidi H.R. et al. Insights from the STICH trial: change in left ventricular size after coronary artery bypass grafting with and without surgical ventricular reconstruction. J. Thorac Cardiovasc Surg 2013;146 (5):1139-1135.

21. Medrano R., Lowry R. W., Young J. B. et al. Assessment of myocardial viability with 99mTc sestamibi in patients undergoing cardiac transplantation. Circulation 1996;94:1010-1017.

22. Nelson C. H., McCrohon J., Khafagi F. et al. Impact of scar thickness on the assessment of viability using dobutamine echocardiography and thallium single-photon emission computed tomography. JACC 2004;43:1248-1246.

23. Остроумов Е. Н., Абрамова Н. Н., Котина Е. Д. и др. Ишемическая кардиомиопатия или аневризма левого желудочка. Кардиология и сердечно-сосудистая хирургия 2012;2:11-17