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No differences in rest myocardial blood flow in stunned and hibernating myocardium: insights into the pathophysiology of ischemic cardiomyopathy

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The human pathophysiology of stunned, hibernating and scarred myocardium in ischemic cardiomyopathy is a subject of controversy. While the “smart heart” theory postulates that reduced myocardial blood flow (MBF) at rest is responsible for myocytes switching to a state of hibernation, other theories suggest that a reduced myocardial flow reserve (MFR) may be the cause.

Methods

We included 110 patients with ischemic cardiomyopathy. Based on quantitative myocardial perfusion assessment and viability imaging with 13N-NH3 and 18F-FDG positron emission tomography, respectively, as well as wall motion assessment from echocardiography, myocardial tissue was characterized as remote (i.e., normal myocardium), stunned (i.e., dysfunctional but viable myocardium with normal rest perfusion), hibernating (i.e., dysfunctional but viable myocardium with impaired rest perfusion), or scarred myocardium (i.e., non-viable myocardium).

Results

Compared to remote myocardium, dysfunctional but viable myocardium (including stunned and hibernating) had reduced rest MBF (0.89 mL/min/g vs. 0.79 and 0.76 mL/min/g, respectively; p < 0.001) and MFR (1.53 vs. 1.27 and 1.17; p < 0.001). Between stunned and hibernating myocardium, however, rest MBF and MFR did not differ (p = 0.40). In scarred myocardium, rest MBF was lowest (0.66 mL/min/g; p < 0.001) but, in contrast to the other myocardial states, k2 (i.e., tracer washout) was increased (0.199/min vs. 0.178/min to 0.181/min; all p < 0.05 in pairwise comparison).

Conclusions

In patients with ischemic cardiomyopathy, impaired MFR is associated with stunning and hibernation. These states of dysfunctional but viable myocardium have lower rest MBF compared to remote myocardium. At the end of the continuum, rest MBF is lowest in scar tissue and linked to increased rate of tracer washout.

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Acknowledgements

We thank Verena Weichselbaumer, Martina Vogt, Tania Lagrange, Kevin Frei, Kathrin Amsler, Frederic Koszarski und Bejtulah Salahi for their excellent technical support.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, CH-8091, Zurich, Switzerland

    Dominik C. Benz, Anita P. von Dahlen, Wenjie Huang, Michael Messerli, Elia von Felten, Georgios Benetos, Andreas A. Giannopoulos, Tobias A. Fuchs, Christoph Gräni, Catherine Gebhard, Aju P. Pazhenkottil, Oliver Gaemperli, Philipp A. Kaufmann & Ronny R. Buechel

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  1. Dominik C. Benz
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  2. Anita P. von Dahlen
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Correspondence to Ronny R. Buechel.

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Conflict of interest

The University Hospital Zurich holds a research agreement with GE Healthcare. Dominik C. Benz has received research grants from the Theodor and Ida Herzog-Egli Foundation. Anita Schneider declares that she has no conflict of interest. Wenjie Huang declares that he has no conflict of interest. Michael Messerli declares that he has no conflict of interest. Elia von Felten declares that he has no conflict of interest. Georgios Benetos declares that he has no conflict of interest. Andreas A. Giannopoulos declares that he has no conflict of interest. Tobias A. Fuchs declares that he has no conflict of interest. Christoph Gräni declares that he has no conflict of interest. Catherine Gebhard declares that he has no conflict of interest. Aju P. Pazhenkottil declares that he has no conflict of interest. Oliver Gaemperli declares that he has no conflict of interest. Philipp A. Kaufmann declares that he has no conflict of interest. Ronny R. Buechel declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the local research committee (Ethics Committee Zurich, BASEC-Nr. 2016-00177) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was waived for all patients scanned before 2014 due to subsequent use of non-genetic personal health data only. For all patients scanned afterward (after the adoption of a new law in Switzerland), written informed consent was obtained.

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Dominik C. Benz and Anita P. von Dahlen share first authorship

This article is part of the Topical Collection on Cardiology

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Benz, D.C., von Dahlen, A. ., Huang, W. et al. No differences in rest myocardial blood flow in stunned and hibernating myocardium: insights into the pathophysiology of ischemic cardiomyopathy. Eur J Nucl Med Mol Imaging 46, 2322–2328 (2019). https://doi.org/10.1007/s00259-019-04440-2

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