Radionuclide imaging in patients with ischemic heart failure

Nuclear imaging procedures are well-established diagnostic tools in clinical cardiology, providing noninvasive information about myocardial perfusion, cardiac function and metabolism. Scintigraphic parameters provide relevant information that aids in everyday clinical decision making for referring physicians. In patients with coronary artery disease, the presence of myocardial necrosis, postischemic stunning and hibernation can determine left ventricular dysfunction leading to ischemic heart failure. The prognosis of these patients is still poor and the long-term results of medical management remain discouraging. It is now well established that ventricular dysfunction is often a reversible process and ventricular function may improve following myocardial revascularization. Patients with extensive areas of hibernation treated medically have a worse prognosis as compared to those who undergo revascularization with a similar extent of viable myocardium. Therefore, an accurate non-invasive assessment of myocardial viability with the preoperative differentiation between hibernation and stunning and irreversibly necrotic tissue is important for clinical decision-making to select patients candidates for revascularization. Radionuclide imaging techniques evaluating myocardial perfusion, cell membrane integrity, ventricular function and cardiac metabolism have demonstrated clinical utility in the assessment of myocardial viability and in predicting improvement of ventricular function and prognosis after coronary revascularization.