Imaging techniques in nuclear cardiology for the assessment of myocardial viability

RHJA Slart*, JJ Bax, DJ van Veldhuisen, EE van der Wall, RAJO Dierckx, PL Jager

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

54 Citations (Scopus)

Abstract

The assessment of myocardial viability has become an important aspect of the diagnostic and prognostic work-up of patients with ischemic cardiomyopathy. Although revascularization may be considered in patients with sufficient viable myocardium, patients with predominantly scar tissue should be treated medically. Patients with left ventricular dysfunction who have viable myocardium are the patients at highest risk because of the potential for ischemia but at the same time benefit most from revascularization. It is important to identify viable myocardium in these patients, and radionuclide myocardial scintigraphy is an excellent tool for this. Single-photon emission computed tomography perfusion scintigraphy (SPECT), whether using (201)thallium, Tc-99m-sestamibi, or Tc-99m-tetrofosmin, in stress and/or rest protocols, has consistently been shown to be an effective modality for identifying myocardial viability and guiding appropriate management. Metabolic and perfusion imaging with positron emission tomography (PET) radiotracers frequently adds additional information and is a powerful tool for predicting which patients will have an improved outcome from revascularization. New techniques in the nuclear cardiology field, like attenuation corrected SPECT, dual isotope simultaneous acquisition (DISA) SPECT and gated FDG PET are promising and will further improve the detection of myocardial viability. Also the combination of multislice computed tomography scanners with PET opens possibilities of adding coronary calcium scoring and non-invasive coronary angiography to myocardial perfusion imaging and quantification. Evaluation of the clinical role of these creative new possibilities warrants investigation.

Original languageEnglish
Pages (from-to)63-80
Number of pages18
JournalInternational Journal Of Cardiovascular Imaging
Volume22
Issue number1
DOIs
Publication statusPublished - Feb-2006

Keywords

  • combined cameras
  • myocardial viability
  • nuclear cardiac techniques
  • radiopharmaceuticals
  • review
  • POSITRON-EMISSION-TOMOGRAPHY
  • CORONARY-ARTERY-DISEASE
  • LEFT-VENTRICULAR DYSFUNCTION
  • REST-REDISTRIBUTION TL-201
  • ISCHEMIC-HEART-DISEASE
  • DOBUTAMINE STRESS ECHOCARDIOGRAPHY
  • VIABLE HIBERNATING MYOCARDIUM
  • INCREMENTAL PROGNOSTIC VALUE
  • SPIRAL COMPUTED-TOMOGRAPHY
  • BLOOD-FLOW

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