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Myocardial Viability
Jacob Blackwell, MD; Paige Bennett, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Diagnostic Checklist

          TERMINOLOGY

          • Definitions

            • In patients with ischemic heart failure, concept of myocardial viability leads therapeutic decisions toward medical management, revascularization, or heart transplant
              • Regions of hibernating/stunned myocardium show improved contractility after revascularization (coronary artery bypass grafting or percutaneous artery interventions)
              • Areas of myocardial infarction will not show improved contractility
            • Viability testing important in patients with heart failure
              • 50% of patients with heart failure: Death within 5 years
              • Revascularization: Decreases morbidity and mortality when viable myocardium present

          IMAGING

          • F-18 FDG PET/CT Viability

            • Cardiac Magnetic Resonance Imaging

              • F-18 FDG PET/MR

                DIFFERENTIAL DIAGNOSIS

                  PATHOLOGY

                  • Microscopic Features

                    CLINICAL ISSUES

                    • Presentation

                      • Demographics

                        • Natural History & Prognosis

                          • Treatment

                            DIAGNOSTIC CHECKLIST

                            • Consider

                              • Image Interpretation Pearls

                                • Reporting Tips

                                  Selected References

                                  1. Priamo J et al: Downstream indication to revascularization following hybrid cardiac PET/MRI: preliminary results. Nucl Med Commun. 38(6):515-522, 2017
                                  2. Lee WW: Recent advances in nuclear cardiology. Nucl Med Mol Imaging. 50(3):196-206, 2016
                                  3. Sarikaya I: Cardiac applications of PET. Nucl Med Commun. 36(10):971-85, 2015
                                  4. Slomka P et al: The role of PET quantification in cardiovascular imaging. Clin Transl Imaging. 2(4):343-358, 2014
                                  5. Thut DP et al: Variability in myocardial metabolism on serial tumor (18)F-FDG PET/CT scans. Am J Nucl Med Mol Imaging. 4(4):346-53, 2014
                                  6. Allman KC: Noninvasive assessment myocardial viability: current status and future directions. J Nucl Cardiol. 20(4):618-37; quiz 638-9, 2013
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Top Differential Diagnoses

                                        • Diagnostic Checklist

                                          TERMINOLOGY

                                          • Definitions

                                            • In patients with ischemic heart failure, concept of myocardial viability leads therapeutic decisions toward medical management, revascularization, or heart transplant
                                              • Regions of hibernating/stunned myocardium show improved contractility after revascularization (coronary artery bypass grafting or percutaneous artery interventions)
                                              • Areas of myocardial infarction will not show improved contractility
                                            • Viability testing important in patients with heart failure
                                              • 50% of patients with heart failure: Death within 5 years
                                              • Revascularization: Decreases morbidity and mortality when viable myocardium present

                                          IMAGING

                                          • F-18 FDG PET/CT Viability

                                            • Cardiac Magnetic Resonance Imaging

                                              • F-18 FDG PET/MR

                                                DIFFERENTIAL DIAGNOSIS

                                                  PATHOLOGY

                                                  • Microscopic Features

                                                    CLINICAL ISSUES

                                                    • Presentation

                                                      • Demographics

                                                        • Natural History & Prognosis

                                                          • Treatment

                                                            DIAGNOSTIC CHECKLIST

                                                            • Consider

                                                              • Image Interpretation Pearls

                                                                • Reporting Tips

                                                                  Selected References

                                                                  1. Priamo J et al: Downstream indication to revascularization following hybrid cardiac PET/MRI: preliminary results. Nucl Med Commun. 38(6):515-522, 2017
                                                                  2. Lee WW: Recent advances in nuclear cardiology. Nucl Med Mol Imaging. 50(3):196-206, 2016
                                                                  3. Sarikaya I: Cardiac applications of PET. Nucl Med Commun. 36(10):971-85, 2015
                                                                  4. Slomka P et al: The role of PET quantification in cardiovascular imaging. Clin Transl Imaging. 2(4):343-358, 2014
                                                                  5. Thut DP et al: Variability in myocardial metabolism on serial tumor (18)F-FDG PET/CT scans. Am J Nucl Med Mol Imaging. 4(4):346-53, 2014
                                                                  6. Allman KC: Noninvasive assessment myocardial viability: current status and future directions. J Nucl Cardiol. 20(4):618-37; quiz 638-9, 2013