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Marjorie Bekaert Thomas
Advances in health and medicine.
Cardiovascular Health Channel
Reported March 6, 2013

Thinning of the Heart Muscle Wall Reversible?


(Ivanhoe Newswire) -- Patients with coronary artery disease referred for cardiovascular magnetic resonance and found to have regional myocardial wall thinning of the heart, have limited scar burden that is associated with improved contraction of the heart and reversal of wall thinning after revascularization.  A recent study suggests that myocardial thinning is potentially reversible.
Chronic myocardial infarction is thought to be represented by the regional myocardial wall thinning, but recent case reports incorporating the use of delayed-enhancement cardiovascular magnetic resonance imaging increase the possibility that this point of view is incorrect. 
These reports indicate that myocardial regions with severe wall thinning do not consist entirely of scar tissue, but might actually have minimal to no scarring.  Therefore, some areas of myocardial thinning may represent viable myocardium and could have the potential for recovery of function.
Researchers at Duke University Medical Center in Durham, North Carolina, conducted the study to evaluate patients with regional myocardial wall thinning and to evaluate scar burden and the potential for functional improvement.  The study that was conducted from August 2000 until January 20028, included 1,055 patients with known coronary artery disease (CAD) who underwent CMR imaging.
"Of 201 patients, 19 percent, identified by CMR as having wall thinning, most had significant left ventricular dysfunction, multi-vessel CAD, and thinning of a substantial portion of the left ventricle. Among this cohort, 18 percent of thinned regions had limited or no scarring observed using delayed-enhancement CMR. Because the lack of scarring was associated with significant contractile improvement and reverse remodeling with resolution of wall thinning following revascularization, we believe the data indicate that myocardial thinning is potentially reversible and therefore should not be considered a permanent state," Dipan J. Shah, MD, and colleagues were quoted as saying. 
"We believe our study provides new insights into the pathophysiology of thinned myocardium and more broadly the process of reversible ischemic injury. The data show that thinned myocardium may consist of limited scar tissue and can recover function, concepts that are both inconsistent with current views.  The findings provide rationale for future experimental studies on reversible ischemic injury as well as for clinical studies prospectively testing whether CMR guidance for coronary revascularization decisions can improve patient outcome," the researchers conclude.
SOURCE: JAMA, March 2013
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