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European Radiology

, Volume 12, Issue 5, pp 1061–1080 | Cite as

Imaging of ischemic heart disease

  • Martin J. Lipton
  • Jan Bogaert
  • Larry M. Boxt
  • Richard C. Reba
Cardiac

Abstract.

Despite advances in the understanding and treatment of ischemic cardiomyopathy, characterized by extensive coronary artery disease and left ventricular (LV) dysfunction, the prognosis remains poor with only a 50–60% 5-year survival rate. The composition of atherosclerotic lesions is currently regarded as being more important than the degree of stenosis in determining acute events. If imaging techniques could distinguish vulnerable from stable plaques, then high-risk patient subgroups could be identified. Another important concept is that LV dysfunction may be the result of either scarring due to necrosis or to the presence of myocardial hibernation, in which there is sufficient blood flow to sustain viable myocytes, but insufficient to maintain systolic contraction. This concept of myocardial viability is critical for making optimal clinical management decisions. This review describes how noninvasive imaging methods can be used to distinguish regions of irreversibly injured myocardium from viable but hibernating segments. Technical advances in CT and MR have made imaging of the beating heart possible. Considerable clinical progress has already been made and further cardiac applications are expected. Radiologists therefore have new opportunities for involvement in cardiac imaging but must recognize the political implications as well as the diagnostic potential of these modalities not only for the heart, but also for the whole vascular system. This review focuses on imaging myocardial injury. It compares state-of-the-art CT and MR with more established yet contemporary echocardiography and nuclear scintigraphy.

Heart Ischemia Infarction Myocardial viability Non-invasive imaging CT MRI 

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Copyright information

© Springer-Verlag 2002

Authors and Affiliations

  • Martin J. Lipton
    • 1
  • Jan Bogaert
    • 2
  • Larry M. Boxt
    • 3
  • Richard C. Reba
    • 1
  1. 1.Department of Radiology, University of Chicago, 5841 South Maryland, P220, MC 2026, Chicago, IL 60637, USAUSA
  2. 2.Department of Radiology, Gasthuisberg University Hospital, Katholieke Universiteit Leuven, Herestraat 49, 3000 Leuven, BelgiumBelgium
  3. 3.Department of Radiology, Beth Israel Medical Center, First Avenue at 16th Street, New York, NY 10003, USAUSA

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