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Nuclear Imaging to Assess Infarction, Reperfusion, No-Reflow, and Viability

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Management of Myocardial Reperfusion Injury

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Abstract

Thrombolytic therapy and primary percutaneous coronary have improved the survival of patients with acute myocardial infarction. However, this superior survival leads to an increased prevalence of left ventricular systolic dysfunction and development of heart failure at follow-up. Nuclear imaging permits comprehensive evaluation of patients with coronary artery disease. In the setting of acute myocardial infarction, 99mTc-sestamibi SPECT provides information on myocardium at risk, infarct size and myocardial salvage, well-known measures of the efficacy of reperfusion therapy, and important prognostic markers. In addition, nuclear imaging permits the assessment of no-reflow phenomenon that may take place during thrombolysis or percutaneous revascularization techniques. Timely detection of this phenomenon may help to select the most appropriate therapies to improve the microcirculation of the infarcted areas and, consequently, to improve the contractile function of the myocardium at follow-up. Furthermore, nuclear imaging plays a central role in the evaluation of ischemic heart failure patients with a substantial amount of dysfunctional but viable myocardium who may benefit from coronary revascularization with significant improvements in left ventricular function, heart failure symptoms, and prognosis. This chapter will review the role of nuclear imaging in acute myocardial infarction, with special focus on the relevance of this technique to assess the efficacy of reperfusion therapy. In addition, a detailed appraisal of multimodality imaging for noninvasive assessment of hibernating myocardium will be provided.

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Disclosures

The Department of Cardiology received grants from Biotronik, Medtronic, Boston Scientific Corporation, Lantheus Medical Imaging, St. Jude Medical, GE Healthcare, and Edwards Lifesciences. Dr. Victoria Delgado received consulting fees from Medtronic and St. Jude Medical. Dr. Kai-Hang Yiu is financially supported by the Hong Kong Heart Foundation.

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Authors and Affiliations

  1. Cardiology Department, Leiden University Medical Center, Albinusdreef 2, Leiden, 2300 RC, The Netherlands

    Victoria Delgado M.D., Ph.D., Kai-Hang Yiu MBBS & Jeroen J. Bax M.D., Ph.D.

  2. Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands

    Arend F. L. Schinkel M.D., Ph.D.

  3. Division of Pharmacology, Vascular and Metabolic Diseases, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands

    Arend F. L. Schinkel M.D., Ph.D.

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  1. Victoria Delgado M.D., Ph.D.
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  2. Arend F. L. Schinkel M.D., Ph.D.
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  3. Kai-Hang Yiu MBBS
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  4. Jeroen J. Bax M.D., Ph.D.
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Correspondence to Victoria Delgado M.D., Ph.D. .

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Editors and Affiliations

  1. Medical School, Coronary Artery Disease, Research Group, St George's Hospital, Cranmer Terrace, London, SW17 0RE, United Kingdom

    Juan Carlos Kaski

  2. Hatter Cardiovascular Inst., Div. Medicine, University College London, Chenies Mews 67, London, WC1E 6HX, United Kingdom

    Derek J. Hausenloy

  3. Mayo Graduate School of Medicine, Dept. Cardiovascular Diseases, Mayo Clinic, First Street SW. 200, Rochester, 55905, Minnesota, USA

    Bernard John Gersh

  4. Hatter Cardiovascular Institute, University College London, Chenies Mews 67, London, WC1E 6HX, United Kingdom

    Derek M. Yellon

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Delgado, V., Schinkel, A.F.L., Yiu, KH., Bax, J.J. (2012). Nuclear Imaging to Assess Infarction, Reperfusion, No-Reflow, and Viability. In: Kaski, J., Hausenloy, D., Gersh, B., Yellon, D. (eds) Management of Myocardial Reperfusion Injury. Springer, London. https://doi.org/10.1007/978-1-84996-019-9_8

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