Clinical evidence of myocardial stunning in patients undergoing CABG surgery

Abstract

Although patients who have undergone coronary artery bypass graft (CABG) surgery frequently present with symptoms suggesting that myocardial stunning has occurred, measurements of regional myocardial function and perfusion are difficult in clinical settings. Several studies have used left ventricular function indices (i.e., cardiac index, left ventricular stroke work index, ejection fraction) to assess myocardial stunning immediately following CABG surgery. These changes in ventricular function have been found to be reversible and the clinical data are consistent with the occurrence of myocardial stunning. Myocardial metabolism is also reportedly depressed following CABG surgery. Decreases in myocardial oxygen extraction, consumption, and lactate utilization all point to the presence of myocardial stunning, as do abnormalities in regional wall-motion and electrocardiographic changes (i.e., transient Q waves) described in patients who have undergone CABG surgery. New approaches to differentiating viable from nonviable myocardial tissue will likely include stress echocardiography using new stress agents, ultrasound contrast agents, and high frequency ultrasound.