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.

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.