Radionuclide Imaging of Viable Myocardium: Is it Underutilized?

Current Cardiovascular Imaging Reports

Volumn 4, Issue 3, 2011, Pages 251-261

  Mylonas, Ilias ^a   Beanlands, Rob S B ^a  

^a UNIVERSITY OF OTTAWA HEART INSTITUTE   (Canada)

Author keywords

Heart failure; PET; SPECT; Viability

Indexed keywords

EID: 84873046960     PISSN: 19419066     EISSN: 19419074     Source Type: Journal    
DOI: 10.1007/s12410-011-9074-8     Document Type: Review

References (70)

1. Jones RH, Velazquez EJ, Michler RE, Sopko G, Oh JK, O'Connor CM, et al. Coronary bypass surgery with or without surgical ventricular reconstruction. N Engl J Med. 2009; 360(17): 1705-17.
2. •• D'Egidio G, Nichol G, Williams K, Guo A, Garrard L, deKemp R, Ruddy T, DaSilva J, Humen D, Gulenchyn K, Freeman M, Racine N, Benard F, Hendry P, Beanlands R. Identification of High-Risk Patients With Increasing Ischemic Cardiomyopathy. JACC Cardiovasc Imaging 2009; 2(9): 1060-68. This substudy identifies the amount of mismatch ("mismatch score") needed to derive benefit from revascularization in patients from the PET arm of the PARR-2 Study.
3. Beanlands R, Nichol G, Huszti E, Humen D, Racine N, Freeman M, et al. Investigators P. F-18-Fluorodeoxyglucose Positron Emission Tomography Imaging-Assisted Management of Patients with Severe Left Ventricular Dysfunction and Suspected Coronary Disease. A Randomized Controlled Trial (PARR-2). J Am Coll Cardiol. 2007; 50(20): 2002-12.
4. Zhang X, Liu XJ, Wu Q, Shi R, Gao R, Liu Y, et al. Clinical outcome of patients with previous myocardial infarction and left ventricular dysfunction assessed with myocardial (99m)Tc-MIBI SPECT and (18)F-FDG PET. J Nucl Med. 2001; 42(8): 1166-73.
5. Allman KC, Shaw LJ, Hachamovitch R, Udelson JE. Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis. J Am Coll Cardiol. 2002; 39(7): 1151-8.
6. Schinkel AF, Poldermans D, Rizzello V, Vanoverschelde JL, Elhendy A, Boersma E, et al. Incidence of recovery of contractile function following revascularization in patients with ischemic left ventricular dysfunction. Am J Cardiol. 2004; 93(1): 14-7.
7. Libby P, Bonow R, Zipes D, Mann D. Braunwald's heart disease: A textbook of cardiovascular medicine. 8th Edn ed: Elsevier; 2007.
8. Stirrup J, Maenhout A, Wechalekar K, Anagnostopoulos C. Radionuclide imaging in ischaemic heart failure. Br Med Bull. 2009; 92: 43-59.
9. Camici PG, Wijns W, Borgers M, De Silva R, Ferrari R, Knuuti J, et al. Pathophysiological mechanisms of chronic reversible left ventricular dysfunction due to coronary artery disease (hibernating myocardium). Circulation. 1997; 96(9): 3205-14.
10. Pagano D, Fath-Ordoubadi F, Beatt KJ, Townend JN, Bonser RS, Camici PG. Effects of coronary revascularisation on myocardial blood flow and coronary vasodilator reserve in hibernating myocardium. Heart. 2001; 85(2): 208-12.
11. Vanoverschelde J-LJ, Wijns W, Depre C, Essamri B, Heyndrickx G, Borgers M, et al. Mechanisms of chronic regional postischemic dysfunction in humans. New insights from the study of noninfarcted collateral-dependent myocardium. Circulation. 1993; 87(5): 1513-23.
12. Ghosh N, Rimoldi OE, Beanlands RS, Camici PG. Assessment of myocardial ischaemia and viability: role of positron emission tomography. Eur Heart J.
13. Carluccio E, Biagioli P, Alunni G, Murrone A, Giombolini C, Ragni T, et al. Patients with hibernating myocardium show altered left ventricular volumes and shape, which revert after revascularization: evidence that dyssynergy might directly induce cardiac remodeling. J Am Coll Cardiol. 2006; 47(5): 969-77.
14. Strauss HW, Harrison K, Langan JK, Lebowitz E, Pitt B. Thallium-201 for myocardial imaging. Relation of thallium-201 to regional myocardial perfusion. Circulation. 1975; 51(4): 641-5.
15. Weich HF, Strauss HW, Pitt B. The extraction of thallium-201 by the myocardium. Circulation. 1977; 56: 188-91.
16. Grunwald AM, Watson DD, Holzgrefe Jr HH, Irving JF, Beller GA. Myocardial thallium-201 kinetics in normal and ischemic myocardium. Circulation. 1981; 64(3): 610-8.
17. Okada RD, Boucher CA. Differentiation of viable and nonviable myocardium after acute reperfusion using serial thallium-201 imaging. Am Heart J. 1987; 113(2 Pt 1): 241-50.
18. Kiat H, Berman DS, Maddahi J, De Yang L, van Train K, Rozanski A, et al. Late reversibility of tomographic myocardial thallium-201 defects: an accurate marker of myocardial viability. J Am Coll Cardiol. 1988; 12(6): 1456-63.
19. He YM, Yang XJ, Wu YW, Zhang B. Twenty-four-hour thallium-201 imaging enhances the detection of myocardial ischemia and viability after myocardial infarction: a comparison study with echocardiography follow-up. Clin Nucl Med. 2009; 34(2): 65-9.
20. Gutman J, Berman DS, Freeman M, Rozanski A, Maddahi J, Waxman A, et al. Time to completed redistribution of thallium-201 in exercise myocardial scintigraphy: relationship to the degree of coronary artery stenosis. Am Heart J. 1983; 106(5 Pt 1): 989-95.
21. Bonow RO, Dilsizian V, Cuocolo A, Bacharach SL. Identification of viable myocardium in patients with chronic coronary artery disease and left ventricular dysfunction: comparison of thallium scintigraphy with reinjection and PET imaging with 18F-fluorodeoxyglucose. Circulation. 1991; 83: 26-37.
22. Dilsizian V, Rocco TP, Freedman NMT, Leon MB, Bono RO. Enhanced detection of ischemic but viable myocardium by the reinjection of thallium after stress-redistribution imaging. N Engl J Med. 1990; 323(3): 141-6.
23. Toyama T, Hoshizaki H, Seki R, Isobe N, Oshima S, Taniguchi K, et al. Evaluation of myocardial viability following acute myocardial infarction using 201Tl SPECT after thallium-glucose-insulin infusion-comparison with 18F-FDG positron emission tomography. Ann Nucl Med. 2004; 18(6): 463-8.
24. Chiba H, Kusuoka H, Ohno J, Nishimura T. Glucose-loading thallium-201 myocardial SPECT. J Nucl Med. 1997; 38(4): 573-7.
25. Hasbek Z, Turgut B, Erselcan T, Yalta K, Tandogan I, Ozer G, et al. Evaluation of myocardial viability with thallium-201 infusion MPSPECT after oral glucose application in patients with chronic coronary artery disease. Nucl Med Commun. 2009; 30(10): 779-88.
26. Heiba SI, Yee G, Abdel-Dayem HM, Youssef I, Coppola J. Combined rest redistribution thallium-201 SPECT and low-dose dobutamine contractility assessment in a simple and practical new viability protocol. Ann Nucl Med. 2009; 23(2): 197-203.
27. Jain D. Technetium-99m labeled myocardial perfusion imaging agents. Semin Nucl Med. 1999; 29(3): 221-36.
28. Demirkol MO. Myocardial viability testing in patients with severe left ventricular dysfunction by SPECT and PET. Anadolu Kardiyol Derg. 2008; 8 Suppl 2: 60-70.
29. Beanlands R, Dawood F, Wen WH, McLaughlin PR, Butany J, D'Amati G, et al. Are the kinetics of Technetium 99m-methoxy isobutyl isonitrile affected by cell metabolism and viability? Circulation. 1990; 82(5): 1802-14.
30. Zaret B, Beller G. Clinical nuclear cardiology: State of the art and future directions. 4th ed. Philadelphia: Mosby Elsevier; 2010.
31. Cuocolo A, Pace L, Ricciardelli B, Chiariello M, Trimarco B, Salvatore M. Identification of viable myocardium in patients with chronic coronary artery disease: comparison of thallium-201 scintigraphy with reinjection and technetium-99m-methoxyisobutyl isonitrile. J Nucl Med. 1992; 33(4): 505-11.
32. Marzullo P, Sambuceti G, Parodi O. The role of sestamibi scintigraphy in the radioisotopic assessment of myocardial viability. J Nucl Med. 1992; 33(11): 1925-30.
33. Crean A, Khan SN, Davies LC, Coulden R, Dutka DP. Assessment of myocardial scar; Comparison between F-FDG PET, CMR and Tc-Sestamibi. Clin Med Cardiol. 2009; 3: 69-76.
34. Yang MF, Keng F, He ZX. Nitrate-augmented myocardial perfusion imaging for assessment of myocardial viability: recent advances. Nucl Med Commun. 2009; 30(6): 415-9.
35. Sciagra R, Pellegri M, Pupi A, Bolognese L, Bisi G, Carnovale V, et al. Prognostic implications of Tc-99m sestamibi viability imaging and subsequent therapeutic strategy in patients with chronic coronary artery disease and left ventricular dysfunction. J Am Coll Cardiol. 2000; 36(3): 739-45.
36. Senior R, Kaul S, Raval U, Lahiri A. Impact of revascularization and myocardial viability determined by nitrate-enhanced Tc-99m sestamibi and Tl-201 imaging on mortality and functional outcome in ischemic cardiomyopathy. J Nucl Cardiol. 2002; 9(5): 454-62.
37. Kostkiewicz M, Olszowska M, Przewlocki T, Podolec P, Tracz W. Prognostic value of nitrate enhanced Tc99m MIBI SPECT study in detecting viable myocardium in patients with coronary artery disease. Int J Cardiovasc Imaging. 2003; 19(2): 129-35.
38. He ZX, Yang MF, Liu XJ, Shi RF, Gao RL, Hu SS, et al. Association of myocardial viability on nitrate-augmented technetium-99m hexakis-2-methoxylisobutyl isonitrile myocardial tomography and intermediate-term outcome in patients with prior myocardial infarction and left ventricular dysfunction. Am J Cardiol. 2003; 92(6): 696-9.
39. Bosevski M, Peovska I, Maksimovic J, Vavlukis M, Meskovska S. Prognostic utility of carotid ultrasound and cardiac SPECT imaging in coronary artery bypass patients. Nucl Med Rev Cent East Eur. 2006; 9(1): 12-7.
40. Acampa W, Evangelista L, Sorrentino AR, Petretta M, Luongo L, Cuocolo A. Single-photon emission computed tomography after nitrate administration predicts cardiac events in patients with previous myocardial infarction and left ventricular dysfunction. J Card Fail. 2007; 13(9): 765-8.
41. Sorrentino AR, Acampa W, Petretta M, Mainolfi C, Salvatore M, Cuocolo A. Comparison of the prognostic value of SPECT after nitrate administration and metabolic imaging by PET in patients with ischaemic left ventricular dysfunction. Eur J Nucl Med Mol Imaging. 2007; 34(4): 558-62.
42. Evangelista L, Acampa W, Petretta M, Ferro A, Ricci F, Luongo L, et al. Incremental prognostic value of cardiac single-photon emission computed tomography after nitrate administration in patients with ischemic left ventricular dysfunction. J Nucl Cardiol. 2009; 16(1): 38-44.
43. Beanlands R, Thorn S, DaSilva J, Ruddy T, Maddahi J. Myocardial viability. In: Wahl R, editor. Principles and practices of positron emission tomography. 2nd ed. Philadelphia: Lippincott Williams and Wilkins; 2008.
44. Birnie D, DeKemp RA, Ruddy TD, Tang AS, Guo A, Williams K, et al. Effect of lateral wall scar on reverse remodeling with cardiac resynchronization therapy. Heart Rhythm. 2009; 6(12): 1721-6.
45. Inoue N, Takahashi N, Ishikawa T, Sumita S, Kobayashi T, Matsushita K, et al. Reverse perfusion-metabolism mismatch predicts good prognosis in patients undergoing cardiac resynchronization therapy: a pilot study. Circ J. 2007; 71(1): 126-31.
46. •• Schinkel AF, Bax JJ, Poldermans D, Elhendy A, Ferrari R, Rahimtoola SH. Hibernating myocardium: diagnosis and patient outcomes. Curr Probl Cardiol. 2007; 32(7): 375-410. This study compares the sensitivities and specificities of multiple imaging modalities for the prediction of recovery of regional function after revascularization. FDG PET was found to have the highest sensitivity, while dobutamine echocardiography was found to have the highest specificity.
47. Eitzman D, Al-Aouar Z, Kanter HL, vom Dahl J, Kirsch M, Deeb GM, et al. Clinical outcome of patients with advanced coronary artery disease after viability studies with positron emission tomography. J Am Coll Cardiol. 1992; 20(3): 559-65.
48. Haas F, Haehnel C, Picker W, Nekolla S, Martinoff S, Meisner H, et al. Preoperative positron emission tomographic viability assessment and perioperative and postoperative risk in patients with advanced ischemic heart disease. J Am Coll Cardiol. 1997; 30(7): 1693-700.
49. Yoshida K, Gould KL. Quantitative relation of myocardial infarct size and myocardial viability by positron emission tomography to left ventricular ejection fraction and 3-year mortality with and without revascularization. J Am Coll Cardiol. 1993; 22: 984-97.
50. VomDahl J, Altehoefer C, Sheehan FH, Buechin P, Schulz G, Schwarz ER, et al. Effect of myocardial viability assessed by technetium-99m-sestamibi SPECT and fluorine-18-FDG PET on clinical outcome in coronary artery disease. J Nucl Med. 1997; 38(5): 742-8.
51. Desideri A, Cortigiani L, Christen AI, Coscarelli S, Gregori D, Zanco P, et al. The extent of perfusion-F18-fluorodeoxyglucose positron emission tomography mismatch determines mortality in medically treated patients with chronic ischemic left ventricular dysfunction. J Am Coll Cardiol. 2005; 46(7): 1264-9.
52. Di Carli M, Maddahi J, Rokhsar S, HR S, Bianco-Batlles D, RC B, et al. Long-term survival of patients with coronary artery disease and left ventricular dysfunction: implications for the role of myocardial viability assessment in management decisions. J Thorac Cardiovasc Surg. 1998; 116(6): 997-1004.
53. Pagano D, Lewis M, Townend J, Davies P, Camici P, Bonser R. Coronary revascularization for postischaemic heart failure: how myocardial viability affects survival. Heart. 1999; 82(6): 684-8.
54. Di Carli MF, Davidson M, Little R, Khanna S, Mody FV, Brunken RC, et al. Value of metabolic imaging with positron emission tomography for evaluating prognosis in patients with coronary artery disease and left ventricular dysfunction. Am J Cardiol. 1994; 73(8): 527-33.
55. Beanlands RS, Chow BJ, Dick A, Friedrich MG, Gulenchyn KY, Kiess M, et al. CCS/CAR/CANM/CNCS/CanSCMR joint position statement on advanced noninvasive cardiac imaging using positron emission tomography, magnetic resonance imaging and multidetector computed tomographic angiography in the diagnosis and evaluation of ischemic heart disease--executive summar. Can J Cardiol. 2007; 23(2): 107-19.
56. •• Inaba Y, Chen JA, Bergmann SR. Quantity of viable myocardium required to improve survival with revascularization in patients with ischemic cardiomyopathy: A meta-analysis. J Nucl Cardiol. 2010; Published online. This is a meta-analysis of SPECT, PET, and stress echo showing the amount of viable myocardium needed to produce a survival benefit in patients undergoing revascularization. PET required the least amount of viable myocardium of all other imaging modalities to produce a survival benefit.
57. Abraham A, Nichol G, Williams KA, Guo A, deKemp RA, Garrard L, et al. 18F-FDG PET imaging of myocardial viability in an experienced center with access to 18F-FDG and integration with clinical management teams: the Ottawa-FIVE substudy of the PARR 2 trial. J Nucl Med. 2010; 51(4): 567-74.
58. Renaud J, Klein R, DaSilva J, Beanlands R, DeKemp R. Comparison of 3D versus 2D 13N-ammonia PET myocardial perfusion imaging. J Nucl Med. 2010; 51 Suppl 2: 44P.
59. Ziadi MC, Beanlands R, DeKemp R, Renaud J, RE T, Guo A, et al. Impaired MFR measured using Rb-82 predicts outcomes in patients with suspected ischemia. Circulation. 2009; 120: S320.
60. Paterson I, O'Meara E, Chow B, Ukkonen H, Beanlands R. Advances in Cardiac Imaging for Patients with Heart Failure. Curr Opin Cardiol. 2010; in press.
61. Cornel JH, Bax JJ, Elhendy A, Maat AP, Kimman GJ, Geleijnse ML, et al. Biphasic response to dobutamine predicts improvement of global left ventricular function after surgical revascularization in patients with stable coronary artery disease: implications of time course of recovery on diagnostic accuracy. J Am Coll Cardiol. 1998; 31(5): 1002-10.
62. Choi KM, Kim RJ, Gubernikoff G, Vargas JD, Parker M, Judd RM. Transmural extent of acute myocardial infarction predicts long-term improvement in contractile function. Circulation. 2001; 104(10): 1101-7.
63. Kim RJ, Wu E, Rafael A, Chen EL, Parker MA, Simonetti O, et al. The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med. 2000; 343(20): 1445-53.
64. Schvartzman PR, Srichai MB, Grimm RA, Obuchowski NA, Hammer DF, McCarthy PM, et al. Nonstress delayed-enhancement magnetic resonance imaging of the myocardium predicts improvement of function after revascularization for chronic ischemic heart disease with left ventricular dysfunction. Am Heart J. 2003; 146(3): 535-41.
65. Bello D, Shah DJ, Farah GM, Di Luzio S, Parker M, Johnson MR, et al. Gadolinium cardiovascular magnetic resonance predicts reversible myocardial dysfunction and remodeling in patients with heart failure undergoing beta-blocker therapy. Circulation. 2003; 108(16): 1945-53.
66. Roes SD, Kaandorp TA, Marsan NA, Westenberg JJ, Dibbets-Schneider P, Stokkel MP, et al. Agreement and disagreement between contrast-enhanced magnetic resonance imaging and nuclear imaging for assessment of myocardial viability. Eur J Nucl Med Mol Imaging. 2009; 36(4): 594-601.
67. Chareonthaitawee P, Gersh BJ, Araoz PA, Gibbons RJ. Revascularization in severe left ventricular dysfunction: the role of viability testing. J Am Coll Cardiol. 2005; 46(4): 567-74.
68. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al. 2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the diagnosis and management of heart failure in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009; 119(14): e391-479.
69. Arnold JM, Liu P, Demers C, Dorian P, Giannetti N, Haddad H, et al. Canadian cardiovascular society consensus conference recommendations on heart failure 2006: diagnosis and management. Can J Cardiol. 2006; 22(1): 23-45.
70. Hendel RC, Berman DS, Di Carli MF, Heidenreich PA, Henkin RE, Pellikka PA, et al. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 appropriate use criteria for cardiac radionuclide imaging: a report of the American college of cardiology foundation appropriate use criteria task force, the American society of nuclear cardiology, the American college of radiology, the American heart association, the American society of echocardiography, the society of cardiovascular computed tomography, the society for cardiovascular magnetic resonance, and the society of nuclear medicine. J Am Coll Cardiol. 2009; 53(23): 2201-29.