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Myocardial Viability: Nuclear Medicine Versus Stress Echocardiography
Author(s) -
MARZULLO PAOLO,
PARODI OBERDAN,
SAMBUCETI GIANMARIO,
REISENHOFER BARBARA,
GIMELLI ALESSIA,
GIORGETTI ASSUERO,
BARTOLI MONICA,
L'ABBATE ANTONIO
Publication year - 1995
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/j.1540-8175.1995.tb00552.x
Subject(s) - medicine , thallium , dobutamine , nuclear medicine , cardiology , positron emission tomography , blood flow , dipyridamole , scintigraphy , nuclear imaging , cardiac pet , radiology , hemodynamics , chemistry , inorganic chemistry
The failure of nonimaging techniques in the identification of myocardial viability has promoted the clinical application of radioisotopic and echocardiographic methods. Unfortunately, none of these techniques provides, per se, a 100% predictive accuracy and only few studies have been based on the postoperative improvement in regional wall motion, the absolute “gold standard” for myocardial viability. The recent thallium‐201 protocols (reinjection, late redistribution, rest studies) have provided nuclear cardiology with a cell membrane integrity image able to unmask viable myocardium in more than 85% of viable segments. Sestamibi has been introduced as a nonrecirculating flow tracer able to detect transient ischemia as well as thallium‐201. Its main limit, a high sensitivity to intermediate reductions in coronary blood flow, determines a high incidence of false positive studies. Positron emission tomography allows the evaluation of regional myocardial blood flow and metabolism. The marker of viable myocardium is the mismatch between reduced blood flow and normal or increased uptake of 18‐F fluorodeoxyglucose. This technique allows the detection of viable tissue in most segments showing improved postoperative function. In our experience, applying a multiparametric approach, rest thallium‐201 scan, rest sestamibi, dobutamine, and dipyridamole echocardiography showed a sensitivity and a specificity of 86%, 75%, 82%, 75% and 92%, 84%, 92%, and 89%, respectively, in the detection of residual viability. The main advantages of thallium‐201 are reproducibility and standardization; those of stress echo are low cost and availability. In patients with severely depressed ventricular function, positron emission tomography retains a primary role when compared to thallium‐201 and stress echocardiography.