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Assessment of myocardial viability by thallium-201

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Part of the Developments in Cardiovascular Medicine book series (DICM, volume 226)

Abstract

Over the past 20 years it has become evident that left ventricular (LV) dysfunction in patients with chronic coronary artery disease is not necessarily an irreversible process, but that improvement of LV function following revascularization may occur [1]. This improvement of function can be observed in patients with substantial dysfunctional but viable myocardium. In contrast, when the dysfunction is based upon scar tissue, no improvement after revascularization can be anticipated. Hence, in patients with viable tissue, the improvement of LV function (translating in survival benefit) after revascularization may outweigh the increased risk of revascularization procedures in these patients. Accordingly, much energy has been invested in the development of noninvasive techniques that are capable of identifying patients with dysfunctional but viable myocardium. These techniques are based upon the characteristics of viable myocardium, including cell membrane integrity, intact mitochondria, preserved glucose and (possibly) fatty acid metabolism, and inotropic reserve [2]. Thallium-201 has been used for the assessment of cell membrane integrity [3], mitochondrial activity can be explored with technetium-99m sestamibi [4], glucose and fatty acid metabolism have been evaluated with F18-fluorodeoxyglucose (FDG) [5] and different radioiodinated fatty acids [6], and inotropic reserve can be probed by dobutamine echocardiography [7]. In this chapter, the use of thallium-201 to detect viable myocardium is discussed. Following the paragraphs on the rationale of thallium-201 imaging, the different protocols and the different viability criteria, the available studies using thallium-201 in patients with chronic coronary artery disease are discussed. These include comparative studies (comparing thallium-201 imaging to other “viability techniques”), studies focusing on prediction of functional outcome after revascularization, and studies evaluating the prognostic value of thallium-201 imaging.

Keywords

Viable Myocardium Chronic Coronary Artery Disease Dobutamine Echocardiography Reverse Redistribution Dilsizian Versus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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