The study of myocardial viability is of great importance in the orientation and management of patients requiring myocardial revascularization or angioplasty. The technique of delayed enhancement (DE) is accurate and has transformed the study of viability into an easy test, not only for the detection of fibrosis but also as a binary test detecting what is viable or not. On DE, fibrosis equal to ...

Objective: To assess left ventricular remodelling in patients with reperfused acute myocardial infarction and to study its relation to microvascular damage. Patients: 25 patients successfully treated by primary percutaneous coronary angioplasty for acute myocardial infarction. Setting: University hospital Methods: Indexed end diastolic (EDVi) and end systolic (ESVi) volumes were assessed on adm...

OBJECTIVE To assess left ventricular remodelling in patients with reperfused acute myocardial infarction and to study its relation to microvascular damage. PATIENTS 25 patients successfully treated by primary percutaneous coronary angioplasty for acute myocardial infarction. SETTING University hospital METHODS Indexed end diastolic (EDVi) and end systolic (ESVi) volumes were assessed on a...

In this regard, the temporal pattern of myocardial contrast enhancement on MRI is reported in this issue of Circulation to be a predictive index of potential myocardial viability for reperfused myocardial infarctions.1 With fast MRI, the firstpass distribution of MRI contrast media indicated that despite patency of the target coronary artery with TIMI 3 flow in all patients, reperfusion at the ...

T he time course of absolute myocardial ischemia is rapid. With the interruption of blood flow to the myocardium, aerobic metabolism ceases within 10 seconds,1 and soon even anaerobic metabolism is inhibited due to the accumulation of H', lactate, and other metabolites. To preserve limited in situ stores of preformed high-energy phosphate, systolic contraction is markedly inhibited, generally c...

Myocardial assessment continues to be an issue in patients with coronary artery disease and left ventricular dysfunction. Nuclear imaging has long played an important role in this field. In particular, PET imaging using 18F-fluorodeoxyglucose is regarded as the metabolic gold standard of tissue viability, which has been supported by a wide clinical experience. Viability assessment using SPECT t...

I schemic heart disease with resultant left ventricular (LV) dysfunction is the major underlying cause of heart failure and carries significant morbidity and mortality. Therapeutic endeavors to improve the prognosis of these patients have evolved over the years and include a multifaceted approach aimed at alleviating symptoms and improving ventricular function, and reducing reinfarction and sud...

The last 3 decades have witnessed an unprecedented improvement in the outcome of patients with acute coronary syndromes. The widespread use of thrombolytic therapy and percutaneous coronary interventions, in association with increasingly potent antithrombotic agents, has contributed to significant reductions in mortality and morbidity in these patients. Although overall survival has improved, a...

Cardiac magnetic resonance (CMR) imaging has emerged as an important non-invasive cardiac imaging modality. A versatile technique, it has the potential for comprehensive evaluation of coronary artery disease (CAD): cardiac morphology and function, myocardial perfusion, myocardial viability, coronary artery visualisation and atherosclerotic plaque characterisation. Some of these techniques--vent...

Background DE-CMR (gadolinium contrast enhanced cardiac magnetic resonance imaging) and MPS (nuclear myocardial perfusion scanning) are two widely used techniques to assess myocardial ‘viability’. However each evaluates different aspects of the myocardium where MRI examines scar burden whilst resting MPS assesses respiring myocytes. DE-CMR offers better spatial and temporal resolution, but requ...