Assessment of left ventricular myocardial viability by 3dimensional speckletracking echocardiography in patients with myocardial infarction t has been well recognized that coronary artery disease is an active contributor to the rise in the prevalence of myocardial ischemia or myocardial infarction mi and associated mortality and morbidity. Imaging modalities have become frontline methods in the assessment of viable myocardial tissue, with the aim to stratify patients into optimal. However, the observational studies by rahimtoola 14 indicated that many patients with left ventricular lv dysfunction exhibited improvement of function after revascularisation. Myocardial viability assessment was provided via dse n, or spect n 321, or both n 150. The interpretation of fdg images typically includes a comparison of myocardial perfusion to myocardial metabolism. Myocardial viability and longterm outcomes in ischemic. The presence of glucose activity by fdg imaging provides evidence of viability. Patients with this condition are at high risk for cardiac death and usually have signi. Planar scintigraphy or single photon emission tomography spect can be per. In the clinical setting, a number of techniques key words. A nuclear medicine thallium viability scan is a test used to evaluate the blood flow to the heart. Assessment of myocardial perfusion using contrast echocardiography and the novel techniques of strain, strain rate imaging, and 3d echocardiography are currently under investigation. Multiple imaging techniques have been developed to assess viable and nonviable myocardium by evaluatingperfusion,cellmembraneintegrity,mitochondria,glucose metabolism, scar tissue.
Performance of delayedenhancement myocardial resonance imaging with gadoversetamide contrast for the detection and assessment of myocardial infarction. The first descriptions of what would today be recognized as viable myocardium. Bauner 1, olaf muehling 2, daniel theisen 1, carmel hayes 3, bernd j. Pdf assessment of myocardial viability in patients with. Myocardial viability and survival in ischemic left. Evaluation of myocardial viability radcliffecardiology.
Cardiac magnetic resonance and myocardial viability. Ischaemic cardiomyopathy continues to be the most common aetiology for myocardial dysfunction in developed countries. Assessment of myocardial viability with 3d mri at 3 t. Recent publications have demonstrated the accuracy of cardiac magnetic resonance imaging cardiac mri in assessing myocardial viability, together with. Viable myocardium are myocardial segment s with reduced function that often appear dyssynergic on imaging studies. After a heart attack myocardial infarction, some of the heart muscle may be permanently damaged or scarred. Assessment of myocardial viability in patients with heart failure.
Heart failure is a common cardiac diagnosis and the prevalence is increasing, with a prediction of more than 8 million affected adults in the united states by 2030. Pdf myocardial viability assessment using nuclear imaging. Cts role for myocardial viability assessment springerlink. Whether in the setting of acute or chronic ischemia, dysfunctional myocardium may be viable and maintain the potential for functional recovery. Spect for viability assessment when to use what myocardial viability, but th eir myocardial uptake is flow dependent. New, fast scanning mr methods allow for the analysis of myocardial perfusion and cardiac dysfunction at rest and during the pharmacological stress study, for detection of myocardial viability and visualization of irreversibly changed myocardiumscar tissue. Viability studies hamilton cardiology associates new. Assessment of myocardial viability by cardiovascular.
The concept of hibernating myocardium originated from observations in the 1970s that the myocardial dysfunction seen in patients with chronic coronary artery disease cad was not always permanent. Spect underestimates the extent of myocardial viability. These dyssynergic or dysfunctional myocardial segments are capable of functional recovery, either spontaneously or after the offending insult usually ischaemia is removed by revascularisation. At present, we lack controlled prospective randomized studies, but indications exist from retrospective studies that patients who undergo a preoperative assessment of viability have better inhospital and 1year outcomes when a viability test is added to clinical and angiographic data. Assessment of myocardial viability linkedin slideshare. Myocardial viability assessment by dobutamine echocardiography using tissue doppler and speckletracking. Myocardial viability in ischemic cardiomyopathy the role of myocardial viability assessment in identifying patients with ischemic cardiomyopathy who will benefit from surgical revascularization is. Myocardial viability assessment using nuclear imaging. By continuing to use our website, you are agreeing to our use of cookies. Assessment of myocardial viability in patients with heart. The myocardial uptake of thallium201 is a sarcolemmal membrane nak atpasedependent active process requiring cell membrane integrity, and is therefore indicative of myocardial viability. Stress echocardiography introduction echocardiography has been routinely used in the assessment of myocardial viability. Assessment of myocardial viability with 3d mri at 3 t kerstin u. Noninvasive assessment of myocardial viability may guide pa tient management.
Myocardial viability detected with spect perfusion imaging. Fdg pet acquisition parameters are described in table 3. The pig and patient studies were approved by the responsible. Assessment of myocardial viability in patients with myocardial infarction using twentyfour hour thallium201 late redistribution imaging. Background the assessment of myocardial viability has been used to identify patients with coronary artery disease and left ventricular dysfunction in whom coronaryartery bypass grafting cabg wil. Fatty acids pet, uptake of ffluorodeoxyglucose fdg is a marker of glucose metabolism blood flow n h3, tc 99msestamibi, tc 99mtetrofosmin contractyle reserve low dose dobutamine rwm analysis morphology mr hyperenhancement. Myocardial viability assessment in 18fdg petct study 18fdg pet myocardial viability assessment journal. Multimodality imaging in the assessment of myocardial. Interpretation of cardiac pet myocardial viability studies. Viability, cardiovascular magnetic resonance imaging, late contrast enhancement, dobutamine, inotropic reserve, wall thickness, high energy phosphates. A comparison with 201 t1 emission tomography combined with cine magnetic resonance imaging.
Other parts of the heart may be injured, but not permanently scarred. Assessment of left ventricular myocardial viability by 3. This central role of myocardial viability assessment was supported by observational studies and metaanalyses showing that after revascularization patients with. Radionuclide techniques for the assessment of myocardial. To prospectively evaluate the correlation between a threedimensional 3d delayed enhancement magnetic resonance mr imaging sequence and a twodimensional 2d delayed enhancement mr imaging sequence for noninvasive assessment of myocardial viability in pigs and patients. Noninvasive assessment of myocardial viability may guide patient management. The usefulness of restredistribution thallium imaging in identifying myocardial viability was further supported by ragosta and coworkers, who studied 21 patients with left ventricular dysfunction mean ejection fraction 27% who subsequently underwent bypass surgery. Simultaneous assessment of myocardial viability and function for the detection of hibernating myocardium using ecggated 99 tc mtetrofosmin emission tomography. Cmr assessment of myocardial viability relies primarily on regional contractile function and delayed gadolinium enhancement to determine extent of transmural scar. Characteristics of viable myocardium dysfunctional but viable myocardium has different characteristics and these form the basis for the different imaging modalities that are most frequently used for the assessment of myocardial viability table 2. Multiple imaging techniques have been developed to assess viable and nonviable myocardium by eval uatingperfusion,cellmembraneintegrity,mitochondria,glucose metabolism, scar tissue, and contractile reserve. Cmr is presently one of the major imaging modalities for noninvasive assessment of myocardial viability. Assessment of myocardial viability with thallium201 and. Various methods are available for the assessment of myocardial viability31.
With echocardiography, myocardial viability is commonly assessed using measures of left ventricular lv wall thickness or myocardial contractile reserve. Both tissuedoppler imaging tdi and speckletracking echocardiography ste are used for myocardial strain measurement. Contrastenhanced magnetic resonance imaging mri had been investigated as a potential technique to assess myocardial viability for several years, before the development of gradient echoimaging techniques provided the ability to temporally distinguish perfusion abnormalities created by microvascular obstruction from myocardial. Myocardial viability assessment by contrastenhanced. Bergmann, md, phd the prevalence of left ventricular lv dysfunction and resultant congestive heart failure is increasing. Once this occurs, the area affected will cease to function properly. Thallium201 uptake by myocytes is also a reflection of regional perfusion required for delivery of tracer to the myocyte and viability. Myocardial viability assessment is an important part of cardiac pet to assist physicians to decide upon the best surgical or medical procedures. F18 fdg imaging provides the unique ability to assess metabolic activity in an area of hypoperfusion. The identification of myocardial viability in patients with coronary artery disease and left ventricular dysfunction lvd has important clinical and prognostic. Investigations in humans have used positron emission tomographic metabolic and myocardial blood flow measurements, assessment of gene. Pathophysiology of myocardial ischemia and viability imbalance between oxygen supply.
Assessment of cardiac muscle using imaging methods enables the localization, quantification of viability in dysfunctional myocardium and possibility of anatomical. Myocardial viability assessment in 18fdg petct study. Stunning, hibernation, and assessment of myocardial viability. In the current era of revascularization surgery and interventional cardiology, the assessment of myocardial viability has become an integral component of the diagnostic evaluation of patients with coronary artery disease cad and depressed left ventricular lv function. The use of myocardial strain imaging msi during dobutamine echocardiography dbe may facilitate the prediction of myocardial viability. Early validation study of 64slice multidetector computed tomography for the assessment of myocardial viability and the prediction of left ventricular remodelling after acute myocardial infarction. The use of mce for viability assessment is based on the principle that microvascular integrity is a fundamental prerequisite for myocardial viability. The fact that revascularization with coronary artery bypass grafting cabg could result in the recovery of. Assessment of myocardial viability in patients before. The prognosis for patients with chronic ischemic left ventricular dysfunction is poor, despite advances in different therapies. Of the viability subgroup, 298 participants were randomly assigned to receive medical therapy plus surgical revascularisation cardiac bypass and 303 received solitary medical management. The role of assessment of myocardial viability in identifying patients with ischemic cardiomyopathy who might benefit from surgical revascularization remains controversial. While ste overcomes technical limitations of tdi, it needs validation for prediction of viability.