THE NONINVASIVE ASSESSMENT OF MYOCARDIAL VIABILITY

被引:18
作者
RAGOSTA, M [1 ]
BELLER, GA [1 ]
机构
[1] UNIV VIRGINIA, DEPT INTERNAL MED, DIV CARDIOVASC, BOX 158, CHARLOTTESVILLE, VA 22908 USA
关键词
MYOCARDIAL VIABILITY; RADIONUCLIDE IMAGING; TL-201; POSITRON EMISSION TOMOGRAPHY; TC-99M SESTAMIBI;
D O I
10.1002/clc.4960160704
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The major objective of noninvasive imaging for detection of myocardial viability is to assist in the improved selection of patients with coronary artery disease and severe left ventricular dysfunction who would benefit most from revascularization. The techniques most commonly used to identify viable myocardium are thallium-201 (Tl-201) scintigraphy, positron emission tomography (PET) using a flow tracer in combination with a metabolic tracer, technetium-99m (Tc-99m) sestamibi imaging, and dobutamine echocardiography. On stress Tl-201 scintigraphy, asynergic regions showing normal thallium uptake, an initial defect with delayed redistribution at 3-4 h, late redistribution at 24 h, or defect reversibility after reinjection of a second dose of Tl-201 at rest all suggest preserved viability. The greater the final uptake of Tl-201 in areas of regional myocardial dysfunction preoperatively, the greater the improvement in ejection fraction after coronary, revascularization. Demonstration of uptake of fluoro-18 deoxyglucose (FDG) in regions of diminished blood flow on PET imaging also correlates well with improved systolic function after revascularization. Tc-99m sestamibi may also be useful for assessment of myocardial viability, particularly after thrombolytic therapy for acute myocardial infarction. Dobutamine echocardiography has good positive predictive value for viability determination, but absence of systolic thickening in an akinetic zone in response to intravenous infusion of the drug may still be associated with viable myocardium in 25-50% of segments. Of all the techniques cited above, quantitative resting Tl-201 scintigraphy may be the best approach for distinguishing between viable and irreversibly injured myocardium.
引用
收藏
页码:531 / 538
页数:8
相关论文
共 72 条
  • [51] POPIO KA, 1977, AM J CARDIOL, V39, P944, DOI 10.1016/S0002-9149(77)80206-3
  • [52] QUANTITATIVE PLANAR REST-REDISTRIBUTION TL-201 IMAGING IN DETECTION OF MYOCARDIAL VIABILITY AND PREDICTION OF IMPROVEMENT IN LEFT-VENTRICULAR FUNCTION AFTER CORONARY-BYPASS SURGERY IN PATIENTS WITH SEVERELY DEPRESSED LEFT-VENTRICULAR FUNCTION
    RAGOSTA, M
    BELLER, GA
    WATSON, DD
    KAUL, S
    GIMPLE, LW
    [J]. CIRCULATION, 1993, 87 (05) : 1630 - 1641
  • [53] THE HIBERNATING MYOCARDIUM
    RAHIMTOOLA, SH
    [J]. AMERICAN HEART JOURNAL, 1989, 117 (01) : 211 - 221
  • [54] RAHIMTOOLA SH, 1985, CIRCULATION, V72, P123
  • [55] TECHNETIUM-99M ISONITRILE MYOCARDIAL UPTAKE AT REST .2. RELATION TO CLINICAL MARKERS OF POTENTIAL VIABILITY
    ROCCO, TP
    DILSIZIAN, V
    STRAUSS, HW
    BOUCHER, CA
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1989, 14 (07) : 1678 - 1684
  • [56] COMPARISON OF THALLIUM REDISTRIBUTION WITH REST REINJECTION IMAGING FOR THE DETECTION OF VIABLE MYOCARDIUM
    ROCCO, TP
    DILSIZIAN, V
    MCKUSICK, KA
    FISCHMAN, AJ
    BOUCHER, CA
    STRAUSS, HW
    [J]. AMERICAN JOURNAL OF CARDIOLOGY, 1990, 66 (02) : 158 - 163
  • [57] PREOPERATIVE PREDICTION OF REVERSIBLE MYOCARDIAL ASYNERGY BY POST-EXERCISE RADIONUCLIDE VENTRICULOGRAPHY
    ROZANSKI, A
    BERMAN, D
    GRAY, R
    DIAMOND, G
    RAYMOND, M
    PRAUSE, J
    MADDAHI, J
    SWAN, HJC
    MATLOFF, J
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1982, 307 (04) : 212 - 216
  • [58] USE OF TL-201 REDISTRIBUTION SCINTIGRAPHY IN THE PREOPERATIVE DIFFERENTIATION OF REVERSIBLE AND NON-REVERSIBLE MYOCARDIAL ASYNERGY
    ROZANSKI, A
    BERMAN, DS
    GRAY, R
    LEVY, R
    RAYMOND, M
    MADDAHI, J
    PANTELEO, N
    WAXMAN, AD
    SWAN, HJC
    MATLOFF, J
    [J]. CIRCULATION, 1981, 64 (05) : 936 - 944
  • [59] SANTORO GM, 1990, J AM COLL CARDIOL, V15, P301
  • [60] SCHWAIGER M, 1991, J NUCL MED, V32, P565