Noninvasive cardiovascular imaging for myocardial necrosis, viability, stunning and hibernation: evidence from an umbrella review encompassing 12 systematic reviews, 286 studies, and 201,680 patients

Figures

• 

  Figure 1. Evolution of G-SPECT myocardial perfusion and LV contractility in acute (revascularized) ischaemia. A – (baseline): G-SPECT myocardial bullseye images (perfusion, motion, and thickening) obtained in a 55-year-old man 5 days after LAD acute occlusion-related STEMI treated with primary PCI, showing a severe perfusion defect in a antero-septal, anteral and antero-lateral wall of the left ventricle as well as in the apex accompanied by a significant reduction in LV motion/contractility and thickening (left panel). In this patient, the baseline LVEF was 24% with EDV of 261 ml, ESV of 199 ml, and stroke volume (SV) of 62 ml. The LV volume and filling curves (right panel) show a significantly reduced overall LV contractility. While part of the LV contractility reduction is likely to be neurogenic (stunning) [30, 31], the disruption in the filling curve (“camel’s hump”) may indicate a forming aneurysm of the LV apex. B – (6-month follow-up): Bullseye images indicate improvement in LV perfusion, motion/contractility and thickening (left panel). EF increased to 37% with a reduction of EDV to 203 ml, ESV reduction to 128 ml, and SV increase to 74 ml. One can notice an improvement of both LV…

• 

  Figure 2. Evolution of G-SPECT myocardial perfusion and LV contractility in subacute (revascularized) ischaemia. A – (baseline): G-SPECT myocardial bullseye images obtained in 62-year-old female with subacute myocardial ischemia in 2-vessel coronary artery disease (primary PCI RCA revascularization and LAD revascularization 2 weeks later) demonstrate a significant perfusion defect in the apex and septum regions of the left ventricle accompanied by a significantly decreased in LV motion/contractility and thickening (left panel). One can notice a severe hypoperfusion in the affected areas, but still low tracer uptake indicates viable – most likely hibernating – myocardium in the LAD territory) with LV dilatation (right panel). Baseline LVEF was 32%, with EDV of 194 ml, ESV of 132 ml and SV of 62 ml. The LV volume and filling curves show reduced LV global contractility (right panel). B – (6-month follow-up): Bullseye images indicate improvement in LV perfusion, motion/contractility and thickening – that are more pronounced in the LAD territory (left panel). The results of this study further support the initial diagnosis of hibernating, hypoperfused myocardium at baseline in the LAD territory…