Assessment of myocardial viability

被引:45
作者
Travin, MI [1 ]
Bergmann, SR [1 ]
机构
[1] Montefiore Med Ctr, Beth Israel Med Ctr, Dept Nucl Med, Bronx, NY 10467 USA
关键词
D O I
10.1053/j.semnuclmed.2004.09.001
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
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. (C) 2005 Elsevier Inc. All rights reserved.
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页码:2 / 16
页数:15
相关论文
共 117 条
[1]   Specialized centers for heart failure management [J].
Abraham, WT ;
Bristow, MR .
CIRCULATION, 1997, 96 (09) :2755-2757
[2]   Cardiac resynchronization therapy for heart failure [J].
Abraham, WT ;
Hayes, DL .
CIRCULATION, 2003, 108 (21) :2596-2603
[3]   Myocardial viability during dobutamine echocardiography predicts survival in patients with coronary artery disease and severe left ventricular systolic dysfunction [J].
Afridi, I ;
Grayburn, PA ;
Panza, JA ;
Oh, JK ;
Zoghbi, WA ;
Marwick, TH .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1998, 32 (04) :921-926
[4]   DOBUTAMINE ECHOCARDIOGRAPHY IN MYOCARDIAL HIBERNATION - OPTIMAL DOSE AND ACCURACY IN PREDICTING RECOVERY OF VENTRICULAR-FUNCTION AFTER CORONARY ANGIOPLASTY [J].
AFRIDI, I ;
KLEIMAN, NS ;
RAIZNER, AE ;
ZOGHBI, WA .
CIRCULATION, 1995, 91 (03) :663-670
[5]   Usefulness of positron emission tomography in defining myocardial viability in patients referred for cardiac transplantation [J].
Akinboboye, OO ;
Idris, O ;
Cannon, PJ ;
Bergmann, SR .
AMERICAN JOURNAL OF CARDIOLOGY, 1999, 83 (08) :1271-+
[6]   Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: A meta-analysis [J].
Allman, KC ;
Shaw, LJ ;
Hachamovitch, R ;
Udelson, JE .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2002, 39 (07) :1151-1158
[7]   EFFECT OF NITROGLYCERIN ON CORONARY COLLATERAL FUNCTION DURING EXERCISE EVALUATED BY QUANTITATIVE-ANALYSIS OF TL-201 SINGLE PHOTON-EMISSION COMPUTED-TOMOGRAPHY [J].
AOKI, M ;
SAKAI, K ;
KOYANAGI, S ;
TAKESHITA, A ;
NAKAMURA, M .
AMERICAN HEART JOURNAL, 1991, 121 (05) :1361-1366
[8]  
Baliga RR, 2000, DEV CARDIOVASC MED, V226, P21
[9]   Assessment of myocardial viability by dobutamine echocardiography, positron emission tomography and thallium-201 SPECT - Correlation with histopathology in explanted hearts [J].
Baumgartner, H ;
Porenta, G ;
Lau, YK ;
Wutte, M ;
Klaar, U ;
Mehrabi, M ;
Siegel, RJ ;
Czernin, J ;
Laufer, G ;
Sochor, H ;
Schelbert, H ;
Fishbein, MC ;
Maurer, G .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1998, 32 (06) :1701-1708
[10]  
Bax Jeroen J., 2000, Seminars in Nuclear Medicine, V30, P281, DOI 10.1053/snuc.2000.9543