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We provide our users the most up-to-date and accurate information on the treatment and prevention of cardio pathologies in accordance with current American and European clinical guidelines.
The information provided on this website is for educational purposes only and should not be considered medical advice. Always consult a licensed physician for diagnosis and treatment.
Myocardial Viability Scan: What You Need to Know
Introduction
A myocardial viability scan is a diagnostic test used to determine whether heart muscle that has been damaged (for example, due to a heart attack) still has living cells that could recover function if blood flow is restored. This is particularly important in patients with coronary artery disease (CAD) and heart failure, as it helps doctors decide whether procedures like bypass surgery or angioplasty might improve heart function.
Why is Myocardial Viability Important?
When heart muscle is deprived of oxygen due to blocked arteries, it can either: 1. Die (infarcted tissue) – This tissue is permanently damaged and cannot recover. 2. Go into hibernation – The muscle is still alive but has reduced function because of insufficient blood supply. 3. Be stunned – Temporary dysfunction after blood supply has been restored.
If a significant portion of heart muscle is viable, restoring blood flow may improve heart function and prevent heart failure progression.
Methods for Assessing Myocardial Viability
Several imaging techniques are used to evaluate myocardial viability:
1. Positron Emission Tomography (PET) Scan
- Uses fluorodeoxyglucose (FDG-PET) to differentiate viable from non-viable myocardium.
- Gold standard for viability assessment.
2. Cardiac Magnetic Resonance Imaging (CMR) with Late Gadolinium Enhancement (LGE)
- Shows scar tissue vs. viable myocardium.
- Helps assess the extent of myocardial damage.
3. Dobutamine Stress Echocardiography (DSE)
- Uses low-dose dobutamine to see if weakened heart muscle improves with stimulation.
4. Single Photon Emission Computed Tomography (SPECT) Scan
- Uses radioactive tracers (e.g., thallium-201 or technetium-99m) to assess blood flow and viability.
When is a Myocardial Viability Scan Recommended?
- Chronic heart failure with reduced ejection fraction (HFrEF) where revascularization is considered.
- Patients after a heart attack to assess if damaged areas can recover.
- Severe coronary artery disease (CAD) with reduced heart function.
- Before deciding on bypass surgery (CABG) or angioplasty in patients with heart failure to determine benefit.
Conclusion
A myocardial viability scan is a crucial tool in modern cardiology. It helps determine whether restoring blood flow to damaged heart muscle can improve heart function and guide treatment options. Doctors use different imaging methods (PET, MRI, echocardiography, and SPECT) based on clinical scenarios. If you or a loved one have heart failure or CAD, discussing myocardial viability testing with your cardiologist may help tailor the best treatment plan.
Source recommendations
1. American College of Cardiology/American Heart Association Guidelines for the Management of Patients with Chronic Coronary Artery Disease
- https://www.ahajournals.org/doi/10.1161/CIR.0000000000001168
- https://pubmed.ncbi.nlm.nih.gov/37471501/
- https://www.jacc.org/guidelines/chronic-coronary-disease
- https://www.acc.org/Guidelines/Hubs/Chronic-Coronary-Disease
- https://professional.heart.org/en/science-news/2023-guideline-for-the-management-of-patients-with-chronic-coronary-disease
2. European Society of Cardiology Guidelines on Myocardial Revascularization
- https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/ESC-EACTS-Guidelines-in-Myocardial-Revascularisation-Guidelines-for
- https://academic.oup.com/eurheartj/article/40/2/87/5079120
- https://pubmed.ncbi.nlm.nih.gov/30165437/
- https://academic.oup.com/eurheartj/article/35/37/2541/581070
- https://pubmed.ncbi.nlm.nih.gov/25173339/
3. American Society of Nuclear Cardiology Practice Guidelines for the Clinical Use of Cardiac Radionuclide Imaging
- https://pubmed.ncbi.nlm.nih.gov/14522503/
- https://www.ahajournals.org/doi/10.1161/01.cir.0000080946.42225.4d
- https://www.jacc.org/doi/abs/10.1016/j.jacc.2003.08.011
- https://www.asnc.org/clinical-guidelines-tools/
- https://www.jtcvs.org/article/S0022-5223(18)33502-5/fulltext
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If you or your loved ones experience any of these symptoms, you should consult a doctor in time. Remember that self-medication can be dangerous, and timely diagnosis will preserve the quality and life expectancy.
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