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Myocardial Perfusion Imaging

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  1. Nuclear cardiology
  2. Imaging agents
  3. Detection of coronary heart disease
  4. Pharmacologic stress imaging
  5. Assessment of prognosis
  6. Determination of myocardial viability with single photon emission computed tomography or positron emission tomography
  7. Conclusions
  8. Bibliography

The techniques of nuclear cardiology permit the noninvasive imaging of myocardial perfusion under stress and resting conditions and of resting regional and global function using radionuclide imaging agents and gamma or positron cameras with associated computer processing. Myocardial perfusion imaging is the most commonly performed nuclear cardiology technique, and it is employed most often in conjunction with either exercise or pharmacologic stress intended to produce flow heterogeneity between relatively hypoperfused and normally perfused myocardial regions. Radionuclide angiography, in which technetium-99m (99m Tc)-labeled red blood cells or other 99m Tc-labeled agents are injected intravenously, is used for measurement of left ventricular ejection fraction (LVEF) and assessment of regional wall motion.

[...] Preoperative pharmacologic stress perfusion imaging offers a noninvasive strategy for the detection of physiologically important coronary stenoses that may be associated with an increased risk of early and late cardiac events after peripheral vascular or aortic surgery. Patients who benefit most from preoperative risk assessment using pharmacologic stress perfusion imaging are patients at an intermediate or high risk of having underlying CHD based on clinical and resting ECG variables and who are scheduled to undergo intermediate-risk or high-risk operations. Patients with evidence for inducible ischemia on preoperative perfusion imaging are likely to benefit from preoperative ß-blocker therapy. [...]

[...] Increased FDG activity on clinical PET images in areas of diminished regional blood flow as determined by13 N ammonia imaging is characteristic of myocardial viability. These areas of blood flow/FDG mismatch usually show improved regional function after coronary revascularization. Regions of the heart that show diminished 13 N uptake and FDG uptake "match" pattern) represent predominantly nonviable myocardium, and these segments have only a 10 to 15% probability of showing improved systolic function after revascularization. Patients with CHD with predominantly viable myocardium as the cause of left ventricular dysfunction have better survival and more improvement of heart failure symptoms after revascularization than with medical therapy. [...]

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