Prevalence of hibernating myocardium in patients with severely impaired ischaemic left ventricles

Abstract

Objective - Severe impairment of left ventricular (LV) contraction is associated with an adverse prognosis in patients with ischaemic heart disease. Revascularisation may improve the impaired LV contraction if hibernating myocardium is present. The proportion of patients likely to benefit from this intervention is unknown. Therefore, the prevalence of hibernating myocardium in patients with ischaemic heart disease and severe impairment of LV contraction was assessed. Design - From a consecutive series of patients undergoing coronary angiography for the investigation of chest pain or LV impairment, all patients with ischaemic heart disease and an LV ejection fraction (LVEF) ≤ 30% were identified. These patients underwent positron emission tomography (PET) to detect hibernating myocardium, identified by perfusion metabolism mismatch. Setting - A teaching hospital directly serving 500 000 people. Results - Of a total of 301 patients, 36 had ischaemic heart disease and an LVEF ≤ 30%. Twenty-seven patients had PET images, while nine patients were not imaged because of emergency revascularisation (three), loss to follow up (one), inability to give consent (four), and age < 50 years (one, ethics committee guidelines). Imaged and non-imaged groups were similar in LV impairment, demographic characteristics, and risk factor profile. Fourteen patients (52% of the imaged or 39% of all patients with ischaemic heart disease and LVEF ≤ 30%) had significant areas of hibernating myocardium on PET. Conclusion - It is possible that up to 50% of patients with ischaemic heart disease and severely impaired left ventricles have hibernating myocardium.