Radionuclide Imaging in Decision-Making for Coronary Revascularization in Stable Ischemic Heart Disease
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Purpose of the Review
This review will discuss the current nuclear imaging techniques for defining ischemia and hibernation/viability, their advantages and disadvantages, and the data related to their use to direct revascularization decisions.
Recent interventional trials highlight the importance of functional imaging in trying to determine who may benefit from revascularization. Outcome benefit from revascularization has previously been shown in patients with significant ischemia, and flow quantification from positron emission tomography (PET) may allow for further risk stratification; similar data may soon be available with single-photon emission computed tomography (SPECT) as well using the newer cadmium-zinc-telluride (CZT) cameras. Some degree of equipoise still exists regarding the utilization of myocardial viability to guide revascularization in patients with ischemic cardiomyopathy, with recent studies presenting conflicting results.
There is a niche for radionuclide imaging in helping to guide revascularization decision-making, and advances in recent years are providing new mechanisms by which we may better clarify the particular circumstances in which it can and should be applied. However, most data at this time is limited to observational cohorts and inferences from other randomized trials. The results of upcoming trials like ISCHEMIA and AIMI-HF will hopefully provide the needed evidence to support current clinical practice, or may change our algorithms altogether.
KeywordsNuclear imaging Coronary revascularization Coronary artery disease Myocardial viability
Compliance with Ethical Standards
Conflict of Interest
Robert A deKemp reports grants from Canadian Institutes of Health Research during the conduct of the study, grants from Jubilant DraxImage outside the submitted work, and a patent Rubidium Generator Technologies licensed to Jubilant DraxImage. Rob SB Beanlands reports grants and personal honorarium from GE, Lantheus Medical Imaging, and Jubilant DRAXImage, outside the submitted work. All other authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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