Assessment of myocardial viability by radionuclide and echocardiographic techniques: is it simply a sensitivity and specificity issue?
OBJECTIVE
The assessment of myocardial viability provides important information that may guide therapeutic decisions in patients with coronary artery disease and left ventricular dysfunction. This review describes methods for assessing myocardial viability using single-photon emission computed tomography, with an emphasis on how to optimize the detection of viable myocardium using current techniques. Relevant comparisons of radionuclide techniques with echocardiographic methods are also discussed.


RESULTS
The basis for the assessment of myocardial viability using radionuclides is reviewed briefly. Radionuclide techniques provide important prognostic information that may affect the decision on if patients with coronary artery disease should be revascularized or treated medically. Data suggest that dobutamine stress echocardiography may underestimate viability in certain patients. Radionuclide techniques that assess both radiotracer uptake and ventricular function can provide a comprehensive approach to detect viable myocardium in most patients.


CONCLUSIONS
The methods for assessing myocardial viability using single-photon emission computed tomography are accurate, reproducible, and widely available. Viability testing should be considered in patients with known coronary artery disease and left ventricular dysfunction. Further studies are warranted to assess the affect of viability assessment on clinical outcomes.
Arrighi
James A
JA
Department of Medicine and Diagnostic Imaging, Brown Medical School, Providence, Rhode Island, USA. jarrighi@lifespan.org
Dilsizian
Vasken
V
D003324:Coronary Artery Disease / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D004452:Echocardiography / Q000379:methods*; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D009200:Myocardial Contraction / Q000502:physiology; D011379:Prognosis; D012680:Sensitivity and Specificity; D014022:Tissue Survival / Q000502:physiology*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology