Journal of Nuclear Cardiology

, Volume 1, Supplement 2, pp S86–S96 | Cite as

Merits and limitations of radionuclide approaches to viability and future developments

  • Heinrich R. Schelbert


Radionuclide imaging approaches have proved useful for the noninvasive identification of a potentially reversible impairment of contractile function in human myocardium. Foremost among these approaches are (1) the thallium 201 uptake, redistribution, and reinjection technique and (2) the evaluation of blood flow and metabolism with positron emission tomography (PET). Both general approaches appear equally accurate in predicting the postrevascularization outcome of regional contractile function. In patients with severely depressed left ventricular function who are likely to benefit most from viability assessments, the available evidence suggests that the metabolic approach with PET outperforms the more conventional approach with201Tl. Several investigations have suggested that PET can identify those patients with a low probability of long-term survival, as well as patients in whom revascularization will reduce mortality rates, improve global left ventricular function, and relieve related symptoms of congestive heart failure. Moreover, several new radionuclide techniques are currently emerging. They probe key points of viable myocardium, such as residual oxidative metabolism, fatty acid uptake and oxidation, membrane function, and cellular homeostasis. Although initial observations have been encouraging, further validation and especially testing in those patients in whom viability assessment is clinically critical will be required. These new approaches may also offer new insights into the mechanisms of reversible contractile dysfunction in the human myocardium.

Key Words

myocardial viability positron emission tomography metabolism thallium 201 fluorine 18-labeled deoxyglucose 


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Copyright information

© American Society of Nuclear Cardiology 1994

Authors and Affiliations

  • Heinrich R. Schelbert
    • 1
    • 2
  1. 1.From the Division of Nuclear Medicine, Department of PharmacologySchool of MedicineUSA
  2. 2.the Laboratory of Nuclear Medicine, Laboratory of Biomedical and Environmental SciencesUniversity of CaliforniaLos Angeles

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