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Assessment of Myocardial Viability in Patients with Heart Failure^*

¹ Thoraxcenter, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands; ² Department of Cardiology, Marshfield Clinic, Marshfield, Wisconsin; and ³ Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

View larger version (9K): [in this window] [in a new window]   FIGURE 1.  Analysis (25) of pooled data from 24 prognostic studies that used different viability techniques and that showed 3.2% annual death rate in patients who had viable myocardium and who were undergoing revascularization, compared with 16% annual death rate in patients who had viable myocardium and who were treated medically. Intermediate event rates (7.7% and 6.2%) were observed in patients with nonviable myocardium.

View larger version (79K): [in this window] [in a new window]   FIGURE 2.  PET with 13N-ammonia and 18F-FDG to assess myocardial viability (26). Regional myocardial 18F-FDG uptake is disproportionately enhanced compared with regional myocardial blood flow; this pattern is termed perfusion–metabolism mismatch and is indicative of hibernating myocardium.

View larger version (21K): [in this window] [in a new window]   FIGURE 3.  Corresponding series of 201Tl rest–redistribution SPECT short-axis slices. Early slices (top) show defect in inferoseptal wall, with redistribution on late slices (bottom).

View larger version (81K): [in this window] [in a new window]   FIGURE 4.  Contrast-enhanced MRI studies. (Left) Short-axis slice from patient with (not completely transmural) anteroseptal infarct. (Right) Short-axis slice from patient with subendocardial inferior infarct.

View larger version (12K): [in this window] [in a new window]   FIGURE 5.  Effect of delayed vs. timely revascularization on change in LVEF in patients with substantial viability on dobutamine stress echocardiography (69). Patients with early revascularization showed significant improvement in LVEF after revascularization, which was not observed after delayed revascularization.

View larger version (9K): [in this window] [in a new window]   FIGURE 6.  Cardiac events (including cardiac death, infarction, and hospitalization for heart failure) during 3-y follow-up according to substantial viability (4 viable segments) and LV end-systolic volume (ESV). Patients with small LV (ESV of <130 mL) and substantial viability had best prognosis (5% event rate), whereas patients without viability and large LV (ESV of 130 mL) had worst prognosis (67% event rate). (Modified from (70).)

View larger version (118K): [in this window] [in a new window]   FIGURE 7.  Contrast-enhanced MRI study. Four-chamber view of heart of patient with ischemic cardiomyopathy and LV dilatation; note (ischemic) mitral valve regurgitation secondary to annular dilatation.