(Circulation. 1998;97:833-838.)
© 1998 American Heart Association, Inc.
Steps Forward in the Assessment of Myocardial Viability in Left Ventricular Dysfunction
James E. Udelson, MD
From the Division of Cardiology, Department of Medicine, New England
Medical Center Hospitals, Tufts University School of Medicine, Boston, Mass.
Correspondence to James E. Udelson, MD, New England Medical Center Hospitals, Division of Cardiology/Box 70, 750 Washington St, Boston, MA 02111. E-mail judelson@es.nemc.org
Key Words: Editorials • ventricles • imaging
The compelling
pathophysiology of the states of reversible LV dysfunction, myocardial
hibernation, and myocardial stunning have spawned a voluminous
literature as clinical investigators attempt to optimize the
noninvasive identification of patients with these conditions before
consideration of revascularization. Such techniques
have direct relevance in patients with clinical syndromes associated
with LV dysfunction. This is perhaps most important and most relevant
in patients with a clinical syndrome of heart failure and a significant
degree of global LV dysfunction, a subset of whom will derive
considerable benefit in terms of outcome and recovery of LV function
after revascularization. Several studies have now
suggested that revascularization in the setting of
LV dysfunction and significantly retained myocardial viability is
associated with an improved natural history1 2 3 4 5
as well as improvement in heart failure symptoms and functional
capacity.6 Besides providing clinically relevant
data, noninvasive scintigraphic and echocardiographic
techniques have also helped to illuminate the complex perfusion,
metabolic, and functional correlates of these states of
reversible LV dysfunction, which remain subjects for
debate.7 8
Traditionally, the scintigraphic techniques for evaluation of
myocardial viability could be broadly categorized into the SPECT method
and agents assessing both perfusion and cell membrane integrity, and
PET with tracers assessing perfusion and metabolic
activity, including features of both cellular fatty acid and glucose
metabolism.9 More recently, however,
these distinctions have blurred with the advent of high-energy
collimators for SPECT imaging of positrons,10 11
allowing the potential for the more widely available SPECT imaging
technique to assess metabolic activity with
18FDG. Because PET technology is . . . [Full Text of this Article]
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