Assessment of myocardial viability

Mark I. Travin, Steven R. Bergmann

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

The prevalence of left ventricular (LV) dysfunction and resultant congestive heart failure is increasing. Patients with this condition are at high risk for cardiac death and usually have significant limitations in their lifestyles. Although there have been advances in medical therapy resulting in improved survival and well being, the best and most definitive therapy, when appropriate, is revascularization. In the setting of coronary artery disease, accounting for approximately two thirds of cases of congestive heart failure, LV dysfunction often is not the result of irreversible scar but rather caused by impairment in function and energy use of still viable-myocytes, with the opportunity for improved function if coronary blood flow is restored. Patients with LV 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, whether using thallium-201, 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 imaging with positron emission tomography radiotracers frequently adds additional information and is a powerful tool for predicting which patients will have an improved outcome from revascularization, including some patients referred instead for cardiac transplantation. Other noninvasive modalities, such as stress echocardiography, also facilitate the assessment of myocardial viability, but there are advantages and disadvantages compared with the nuclear techniques. Nuclear imaging appears to require fewer viable cells for detection, resulting in a higher sensitivity but a lower specificity than stress echocardiography for predicting post-revascularization improvement of ventricular function. Nevertheless, it appears that LV functional improvement may not always be necessary for clinical improvement. Future directions include use of magnetic resonance imaging, as well as larger, multicenter trials of radionuclide techniques. The increasing population of patients with LV dysfunction, and the increased benefit afforded by newer therapies, will make assessment of myocardial viability even more essential for proper patient management.

Original languageEnglish (US)
Pages (from-to)2-16
Number of pages15
JournalSeminars in Nuclear Medicine
Volume35
Issue number1
DOIs
StatePublished - Jan 2005

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Left Ventricular Dysfunction
Stress Echocardiography
Radioisotopes
Myocardium
Heart Failure
Myocardial Perfusion Imaging
Perfusion Imaging
Ventricular Function
Thallium
Heart Transplantation
Single-Photon Emission-Computed Tomography
Positron-Emission Tomography
Muscle Cells
Multicenter Studies
Cicatrix
Life Style
Coronary Artery Disease
Therapeutics
Ischemia
Magnetic Resonance Imaging

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Assessment of myocardial viability. / Travin, Mark I.; Bergmann, Steven R.

In: Seminars in Nuclear Medicine, Vol. 35, No. 1, 01.2005, p. 2-16.

Research output: Contribution to journalArticle

Travin, Mark I. ; Bergmann, Steven R. / Assessment of myocardial viability. In: Seminars in Nuclear Medicine. 2005 ; Vol. 35, No. 1. pp. 2-16.
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