Echocardiographic Assessment of Myocardial Viability

  • Eugenio Picano


A cell is considered dead when some basic aspects of cell behavior no longer function. These aspects may be intermediary metabolism (imaged by fluorodeoxyglucose uptake and positron emission tomography) or membrane integrity (imaged by thallium uptake and gamma-camera) [1]. The basic aspect of cell behavior offering a clue for viability recognition by stress echocardiography is regional function. As we saw in Chap. 4 (“Biochemical basis of stress echocardiography”), at rest about 60% of the high-energy phosphates produced by cell metabolism are used for de-velopment of contractile force and 20% for “wear and repair” [2]. In several conditions, when the local supply-demand balance of the cell is critically endangered (ischemia, hibernation, stunning: see Chap. 4, Fig. 3), the cell minimizes energy expediture into cardiac work and utiliz-es whatever is left for the maintenance of cellular integrity. The de-pressed function is indistinguishable from the infarction state [3], but, unlike necrosis, the cell can “play dead” like an opossum exhibiting a sympathoinhibitory reaction in the presence of danger; it looks dead but remains metabolically viable. The main differences between stunning and hibernation were discussed in Chap. 3 and are summarized in Ta-ble 1. In its simplest sense, myocardial stunning may be considered, ac-cording to D. J. Hearse [4], the expression of a post-ischemic “hang-over”, a phase of organ malfunction and recovery that inevitably follows a period of trauma. Whether caused by an excess of alcohol, a bout of influenza, or transient ischemia, there are few pathologic states in which a complete and instantaneous recovery is observed as soon as the source of initition is removed [4]. In its simplest sense, the hibernating heart is a “smart heart” reducing the energy output to cope with a critical reduc-tion in energy input, awaiting in this noncontractile state the return of summer after winter and willing to contract normally whenever warm coronary blood is restored [4]. Although their distinction is clear-cut


Myocardial Viability Stress Echocardiography Dobutamine Stress Echocardiography Stun Myocardium Contrast Echocardiography 
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Copyright information

© Springer-Verlag Berlin Heidelberg 1994

Authors and Affiliations

  • Eugenio Picano
    • 1
  1. 1.Institute of Clinical PhysiologyCNRPisaItaly

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