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European Heart Journal Advance Access published online on June 13, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn266
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Time course of functional recovery after revascularization of hibernating myocardium: a contrast-enhanced cardiovascular magnetic resonance study

Olga Bondarenko1,*, Aernout M. Beek1, Jos W.R. Twisk2, Cees A. Visser1,{dagger} and Albert C. van Rossum1

1 Department of Cardiology, VU University Medical Centre, De Boelelaan 1117, Amsterdam HV 1081, The Netherlands
2 Department of Clinical Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands

Received 10 June 2007; revised 25 May 2008; accepted 29 May 2008.

* Corresponding author. Tel: +31 20 4442244, Fax: +31 20 4442446, Email: o.bondarenko{at}vumc.nl

Aims: 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.

Methods and 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).

Conclusion: 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.

Key Words: Magnetic resonance imaging • Contrast media • Revascularization • Follow-up studies

{dagger} Deceased in January 2007.


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