Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0599766 (functional recovery)
 13,441 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The management of patients with coronary artery disease, both in the post-infarction setting, and in patients with chronic advanced left ventricular (LV) dysfunction, is complicated by the presence of both reversibly damaged and infarcted myocardium. Although acute revascularization with thrombolytic therapy and percutaneous angioplasty have served to reduce the overall mortality from myocardial infarction, the ability to predict whether or not dysfunctional myocardium will recoverfollowing revascularization presents the clinician with a serious challenge. The success of revascularization, both on improvement of LV function, and short and long-term prognosis, depends on both the existence and extent of viable but dysfunctional myocardium present, as there is little to be gained from revascularizing a territory consisting exclusively of scar. There is a clear demand for procedures that can identify reversible asynergy prospectively and thus deliver the information that is needed for clinical decision-making. The objective of this review is to summarize the diagnostic tools that are currently availablefor the identification of reversible injury (ie., stunned or hibernating myocardium). The relative merits of echocardiography, nuclear medicine imaging, and magnetic resonance imaging are discussed in detail. Within the discussion of each modality, special attention is paid to the more recent innovations that have arisen to enhance the diagnostic and prognostic value of older approaches. Cost, availability, and local expertise will always affect the clinical popularity of a given diagnostic approach. However, the overriding conclusion that emerges from this review is that the future "techniques of choice" will be those that can reliably predict and quantify the extent of potential functional recovery.
 ...
PMID:The assessment of myocardial viability: a review of current diagnostic imaging approaches. 1223 10

Previous studies have demonstrated that myocardial perfusion imaging using 99mTc-tetrofosmin at rest allows viability assessment similar to that obtained with 201Tl imaging and 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET). The simultaneous assessment of perfusion and regional function is now available by quantitative gated myocardial perfusion single-photon emission computed tomography (SPECT). This study was designed to evaluate the utility of quantitative values of wall motion and wall thickening, calculated by quantitative gated myocardial perfusion SPECT, for the prediction of functional recovery after coronary bypass grafting (CABG). Fifty-six patients with coronary artery disease scheduled for CABG were included prospectively. All patients underwent 99mTc-tetrofosmin gated SPECT imaging at rest preoperatively and 3 months after CABG. The myocardium was divided into nine segments and the average quantitative values of regional perfusion (percentage uptake) (%), wall motion (mm) and wall thickening (%) were determined automatically using quantitative gated SPECT (QGS) software. The wall motion score was defined visually using a four-point scale (0, normal; 3, akinesis), and segments with severe asynergy (score of 2 or 3) with patent grafts were assessed. Of 77 segments with severe asynergy, 56 segments showed improved wall motion and 21 segments did not improve after CABG. The area under the receiver operating characteristic curve of wall thickening for the prediction of functional recovery was significantly higher (0.92) than that of the percentage uptake (0.77, P<0.017) or wall motion (0.60, P<0.0001). When each analysis used the optimal threshold, the wall thickening analysis (>or=10%) had a sensitivity of 95% and a specificity of 81%. These values tended to be higher than those of the percentage uptake (sensitivity, 86%; specificity, 67%). The wall motion analysis (>or=1.5 mm) had a significantly lower sensitivity of 75% and specificity of 43% than the wall thickening analysis (P=0.0038 and P=0.011, respectively). The results indicate that wall thickening, calculated by QGS software, may be more useful than regional perfusion or wall motion analysis for the prediction of functional recovery after CABG. The areas of asynergy with relatively preserved wall thickening may have the potential for improved function despite severely decreased perfusion.
 ...
PMID:Prediction of functional recovery after coronary bypass surgery using quantitative gated myocardial perfusion SPECT. 1276 97


<< Previous 1 2