Hybrid Imaging in the Assessment of Myocardial Ischemia and Viability

Open access


Myocardial ischemia results from a reduction in blood flow as a consequence of a coronary stenosis, which produces ischemia in the myocardial territories irrigated by the stenotic artery. Myocardial viability is a concept that derived from several studies in which it was observed that, even if revascularization occurred, an irreversible left ventricular contractile dysfunction remained. The terms “stunned” and “hibernating” myocardium have been traditionally associated with the viable myocardium, and many controversies still exist on the most appropriate method to assess the presence and extent of viable myocardium. During the last decades, many efforts have been made to identify the best method to determine the viability of the myocardial tissue. Due to the fact that none of the stand-alone imaging methods provide sufficient data about myocardial viability, new methods for the investigation of myocardial viability became necessary. Thus, the concept of hybrid imaging was developed, consisting in the association of different imaging techniques, finally resulting in a single image that offers all the details provided by the two isolated methods of diagnosis, therefore being more precise in regards to the identification of viable myocardium territory. This review aims to appraise the recent studies related to myocardial viability investigated with hybrid imaging.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. World Health Organization Cardiovascular disease (CVDs) 2016. Available from: http://www.who.int/mediacentre/factsheets/fs317/en/#

  • 2. Townsend N Nichols M Scarborough P Rayner M. Cardiovascular disease in Europe — epidemiological update 2015. Eur Heart J. 2015;36:2673-2674.

  • 3. Nichols M Townsend N Scarborough P Rayner M. Cardiovascular disease in Europe 2014: epidemiological update. Eur Heart J. 2014;35:2950-2959.

  • 4. Camici PG Prasad SK Rimoldi OE. Stunning hibernation and assessment of myocardial viability. Circulation. 2008;117:103-114.

  • 5. Tarakji KG Brunken R McCarthy PM et al. Myocardial viability testing and the effect of early intervention in patients with advanced left ventricular systolic dysfunction. Circulation. 2006;113:230-237.

  • 6. Schinkel AF Bax JJ Poldermans D Elhendy A Ferrari R Rahimtoola SH. Hibernating myocardium: diagnosis and patient outcomes. Curr Probl Cardiol. 2007;32:375-410.

  • 7. Brauwald E Kloner RA. The stunned myocardium: prolonged postischemic ventricular dysfunction. Circulation. 1982;66:1146-1149.

  • 8. Cleland JG Pennell DJ Ray SG et al. Myocardial viability as a determinant of the ejection fraction response to carvedilol in patients with heart failure (CHRISTMAS trial): randomised controlled trial. Lancet. 2003;362:14-21.

  • 9. Partington SL Kwong RY Dorbala S. Multimodality imaging in the assessment of myocardial viability. Heart Failure Reviews. 2011;16:381-395.

  • 10. Yamauchi T Tamaki N Kasanuki H et al. Optimal initial diagnostic strategies for the evaluation of stable angina patients: a multicenter prospective study on myocardial perfusion imaging computed tomographic angiography and coronary angiography. Circ J. 2012;76:2832-2839.

  • 11. Nikolaou K Knez A Rist C et al. Accuracy of 64-MDCT in the diagnosis of ischemic heart disease. Am J Roentgenol. 2006;187:111-117.

  • 12. Ehara M Surmely JF Kawai M et al. Diagnostic accuracy of 64-slice computed tomography for detecting angiographically significant coronary artery stenosis in an unselected consecutive patient population: comparison with conventional invasive angiography. Circ J. 2006;70:564-571.

  • 13. Ropers D Pohle FK Kuettner A et al. Diagnostic accuracy of noninvasive coronary angiography in patients after bypass surgery using 64-slice spiral computed tomography with 330-ms gantry rotation. Circulation. 2006;114:2334-2341.

  • 14. Raff GL Gallagher MJ O’Neill WW Goldstein JA. Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol. 2005;46:552-557.

  • 15. Lardo AC Cordeiro MA Silva C et al. Contrast-enhanced multidetector computed tomography viability imaging after myocardial infarction characterization of myocyte death microvascular obstruction and chronic scar. Circulation. 2006; 24;113:394-404.

  • 16. Bax JJ Delgado V. Myocardial viability as integral part of the diagnostic and therapeutic approach to ischemic heart failure. J Nucl Cardiol. 2015;22:229-245.

  • 17. Wellnhofer E Olariu A Klein C et al. Magnetic resonance low-dose dobutamine test is superior to SCAR quantification for the prediction of functional recovery. Circulation. 2004;109:18:2172-2174.

  • 18. Motoyasu M Sakuma H Ichikawa Y et al. Prediction of regional functional recovery after acute myocardial infarction with low dose dobutamine stress cine MR imaging and contrast enhanced MR imaging. J Cardiovasc Magn Reson. 2003;5:563-574.

  • 19. Van Hoe L Vanderheyden M. Ischemic cardiomyopathy: value of different MRI techniques for prediction of functional recovery after revascularization. Am J Roentgenol. 2004;182:95-100.

  • 20. Klein C Nekolla SG Bengel FM et al. Assessment of myocardial viability with contrast-enhanced magnetic resonance imaging comparison with positron emission tomography. Circulation. 2002;105:162-167.

  • 21. Li Dy Hao J Xia Y et al. Clinical usefulness of low-dose dobutamine stress real-time myocardial contrast echocardiography for detection of viable myocardium. J Clin Ultrasound. 2012;40:272-279.

  • 22. Wang C Han S Xu T et al. Evaluation of myocardial viability in old myocardial infarcted patients with CHF: delayed enhancement MRI vs. low-dose dobutamine stress speckle tracking echocardiography. American Journal of Translational Research. 2016;8:3731-3743.

  • 23. Al Moudi M Sun Z-H. Diagnostic value of 18F-FDG PET in the assessment of myocardial viability in coronary artery disease: A comparative study with 99mTc SPECT and echocardiography. Journal of Geriatric Cardiology. 2014;11:229-236.

  • 24. Masuda A Yamaki T Kunii H et al. Simultaneous Assessment of Myocardial Viability With 18F-fluorodeoxyglucose Uptake and Late Gadolinium Enhancement by PET/MRI. Circulation. 2016;134:A11929

  • 25. Danad I Raijmakers PG Appelman YE et al. Hybrid imaging using quantitative H2 15O PET and CT-based coronary angiography for the detection of coronary artery disease. J Nucl Med. 2013;54:55-63.

  • 26. Kajander S Joutsiniemi E Saraste M et al. Cardiac positron emission tomography/computed tomography imaging accurately detects anatomically and functionally significant coronary artery disease. Circulation. 2010;122:603-613.

  • 27. Schenker MP Dorbala S Hong EC et al. Interrelation of Coronary Calcification Myocardial Ischemia and Outcomes in Patients With Intermediate Likelihood of Coronary Artery Disease A Combined Positron Emission Tomography/Computed Tomography Study. Circulation. 2008;117:1693-1700.

  • 28. Kaufmann PA. Cardiac hybrid imaging: state-of-the-art. Ann Nucl Med. 2009;23:325-331.

Journal information
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 194 57 4
PDF Downloads 89 26 1