Hibernated myocardium and heart failure with recovered ejection fraction. Case report

Abstract

Coronary artery disease will inevitably lead to myocardial dysfunction capable of inducing heart failure (HF). A viable dysfunctional myocardium is defined as one whose contractile function improves after coronary revascularization, either through transluminal coronary angioplasty (TCA), fibrinolysis, or myocardial revascularization surgery. Such dysfunction may present as daze or myocardial hibernation. In the first, the dysfunction will be secondary to a transient, acute and short-term interruption of coronary flow. In the hibernating myocardium there will be a chronic decrease in coronary flow with a consequent chronic ventricular dysfunction.

We present the case of a 66-year-old female patient who was admitted with a diagnosis of advanced NSTEMI. Pathological history: Grade II obesity (BMI 36 kg/m2) and COVID 19 pneumonia (2021) and active smoker: 10 cigarettes a day. The electrocardiogram showed sinus rhythm with fibrosis of the anteroseptal face. Troponin T: 0.056 ng/ml and CPK: 61 ng/ml were observed. The Chest X-ray showed grade 3 cardiomegaly and bilateral radiopacities and grade 2 venocapillary hypertension. The transthoracic echocardiogram: Left Ventricular Diameter in Diastole (LVD): 6.5 cm, Left Ventricular Diameter in Systole (LVDs) 5.4 cm, LVEF: 31% with akinesia of the middle and apical segments of the septal, anterior and apex surfaces and lateral hypokinesia. Coronary angiography was performed that revealed severe obstruction of the Left Main Coronary Artery, critical proximal lesion of the Anterior Descending Artery, critical ostial lesion of the Circumflex Artery  and moderate to severe lesion of the Right Coronary Artery . Therefore, ATC was carried out: to TCI, ADA and ACX. At 3 months, the transthoracic echocardiogram showed: DVId): 5 cm, DVIs 3.7 cm, LVEF 53%, without segmental contractility disorders at rest. The patient is currently stable, in NYHA functional class I.

Aggressive treatment using TCA associated with complete medical treatment with anti-ischemic drugs in the context of a patient with hibernating myocardium, managed to restore coronary flow, improve myocardial dysfunction, and recover the ejection fraction.