Characterization of hibernating myocardium with NOGA electroanatomic endocardial mapping

Because the terms “hibernation” and “viability” are not interchangeable, the recognition of hibernating myocardium within viable segments remained elusive for NOGA electroanatomic endocardial mapping. The aim of the present study was to determine the characteristics of hibernating myocardium in NOGA mapping. Baseline and follow-up endocardial mapping, thallium-201 myocardial perfusion scintigraphy at rest, and contrast ventriculography were performed in 28 patients who had proved viable myocardium before and 7.3 ± 2.5 months after percutaneous coronary intervention. Significantly improved regional wall motion in the revascularized territory (region of interest) was confirmed in 9 patients (group 1) at follow-up (from −2.11 ± 0.87 to −1.48 ± 0.43 SD/chord, p <0.05), whereas no change in regional wall motion was observed in 19 patients (group 2; from −2.56 ± 0.88 to −2.79 ± 0.91 SD/chord). Average normalized thallium uptake at rest increased significantly in groups 1 and 2 after revascularization. A trend toward increased unipolar voltages in the region of interest was observed in group 1 at follow-up (from 10.6 ± 3.5 to 11.7 ± 4.0 mV, p = 0.073), whereas no change was observed in group 2 (from 8.7 ± 4.4 to 8.9 ± 3.8 mV). A significant increase in local linear shortening was measured only in group 1 (from 7.5 ± 5.2% to 10.3 ± 3.9%, p <0.05). Hibernating myocardial segments exhibited significantly higher unipolar voltages and late thallium uptake at rest at baseline. Receiver-operator characteristic analysis showed a mean unipolar voltage of 9.0 mV (predictive accuracy 0.708, common sensitivity and specificity 72%) in the region of interest for prediction of functional recovery. In conclusion, for characterizing the hibernating myocardium within viable segments, NOGA endocardial mapping offers on-line guidance for percutaneous coronary and noncoronary myocardial revascularization.