Assessment of Myocardial Viability with PET

  • Juergen vom Dahl
Part of the Developments in Nuclear Medicine book series (DNUM, volume 28)


Less than 20 years ago, contractile dysfunction of the myocardium in the distribution territory of a stenosed coronary artery was thought to represent either irreversible damage of myocytes due to myocardial infarction and necrosis, or the effects of transient ischemia. However, during the last decade, experimental and clinical studies demonstrated that regional contractile dysfunction may also occur in the absence of myocardial infarction and may persist for a long time after cessation of ischemia with spontaneous normalization of function. Regional dysfunction in viable myocardium may be either temporary and spontaneously reversible following early reperfusion of a previously occluded vessel (myocardial “stunning” [1]) or sustained in the presence of chronic resting hypoperfusion and potentially reversible following restoration of blood flow by coronary revascularization (myocardial “hibernation” [2]).


Positron Emission Tomography Positron Emission Tomography Imaging Myocardial Blood Flow Myocardial Viability Advanced Coronary Artery Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Bolli R. Myocardial ‘stunning’ in man. Circulation 1992; 86: 1671–91.PubMedGoogle Scholar
  2. 2.
    Rahimtoola SH. The hibernating myocardium. Am Heart J 1989; 117: 211–21.PubMedCrossRefGoogle Scholar
  3. 3.
    Schelbert HR. Merits and limitations of raduinuclide approaches to viability and future developments. J Nucl Cardiol 1994; 1 (2/2): 86–96.CrossRefGoogle Scholar
  4. 4.
    Liedtke AJ. Alterations of carbohydrate and lipid metabolism in the acutely ischemic heart. Prog Cardiovasc Dis 1981; 23: 321–36.PubMedCrossRefGoogle Scholar
  5. 5.
    Marshall RC, Tillisch JH, Phelps ME, et al. Identification and differentiation of resting myocardial ischemia in man with positron computed tomography,18Flabeled fluorodeoxyglucose and N-13 ammonia. Circulation 1983; 67: 766–78.PubMedCrossRefGoogle Scholar
  6. 6.
    Tillisch J, Brunken R, Marshall R, et al. Reversibility of cardiac wall-motion abnormalities predicted by positron tomography. N Engl J Med 1986; 314: 884–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Tamaki N, Yonekura Y, Yamashita K, et al. Positron emission tomography using fluorine-18 deoxyglucose in evaluation of coronary artery bypass grafting. Am J Cardiol 1989; 64 (14): 860–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Marwick TH, Maclntyre WJ, Nemec JJ, Go RT, Saha GB. Post-Exercise F-18 Deoxyglucose PET predicts functional recovery of hibernating myocardium after revascularization (abstr). Europ Heart J 1991; 12 (Abstr Suppl): 17.Google Scholar
  9. 9.
    Marwick TH, MacIntyre WJ, Lafont A, Nemec JJ, Salcedo EE. Metabolic responses of hibernating and infarcted myocardium to revascularization. Circulation 1992; 85: 1347–53.PubMedGoogle Scholar
  10. 10.
    Carrel T, Jenni R, Haubold-Reuter S, von Schulthess G, Pasic M, Turina M. Improvement of severely reduced left ventricular function after surgical revascularization in patients with preoperative myocardial infarction. Eur J Cardiothorac Surg 1992; 6: 479–84.PubMedCrossRefGoogle Scholar
  11. 11.
    Gropler RJ, Geltman EM, Sampathkumaran K, et al. Comparison of carbon-1 l-acetate with fluorine-l8-fluorodeoxyglucose for delineating viable myocardium by positron emission tomography. J Am Coll Cardiol 1993; 22: 1587–97.PubMedCrossRefGoogle Scholar
  12. 12.
    vom Dahl J, Eitzman DT, Al-Aouar ZR, Kanter HL, Hicks RJ, Schwaiger M. Relationship between regional function, perfusion, and metabolism in patients with advanced coronary artery disease undergoing surgical revascularization. Circulation 1994; 90: 2355–66.Google Scholar
  13. 13.
    Besozzi MC, Brown MD, Hubner KF, et al. Retrospective post therapy evaluation of cardiac function in 208 coronary artery disease patients evaluated by positron emission tomography. J Nucl Med 1992; 33: 885.Google Scholar
  14. 14.
    Eitzman D, Al-Aouar Z, Kanter HL, et al. Clinical outcome of patients with advanced coronary artery disease after viability studies with positron emission tomography. J Am Coll Cardiol 1992; 20: 559–65.PubMedCrossRefGoogle Scholar
  15. 15.
    Tamaki N, Kawamoto M, Takahashi N, et al. Prognostic value of an increase in fluorine-18 deoxyglucose uptake in patients with myocardial infarction: comparison with stress thallium imaging. J Am Coll Cardiol 1993; 22: 1621–7.PubMedCrossRefGoogle Scholar
  16. 16.
    DiCarli MF, Davidson M, Little R, et al. Value of metabolic imaging with positron emission tomography for evaluating prognosis in patients with coronary artery disease and left ventricular dysfunction. Am J Cardiol 1994; 73: 527–33.CrossRefGoogle Scholar
  17. 17.
    Wisneski JA, Gertz EW, Neese RA, Gruenke LD, Morris L, Craig JC. Metabolic fate of extracted glucose in normal human myocardium. J Clin Invest 1985; 76: 181–927.CrossRefGoogle Scholar
  18. 18.
    Merhige ME, Ekas R, Mossberg K, Taegtmeyer H, Gould KL. Catecholamine stimulation, substrate competition, and myocardial glucose uptake in conscious dogs assessed with positron emission tomography. Circ Res 1987;61(suppl ll)aI 124–9.Google Scholar
  19. 19.
    Schwaiger M, Brunken R, Grover-McKay M, et al. Regional myocardial metabolism in patients with acute myocardial infarction assessed by positron emission tomography. J Am Coll Cardiol 1986;8(800–8).Google Scholar
  20. 20.
    Pierard LA, De Landsheere CM, Berthe C, Rigo P, Kulbertus HE. Identification of viable myocardium by echocardiography during dobutamine infusion in patients with myocardial infarction after thrombolytic therapy: comparison with positron emission tomography. J Am Coll Cardiol 1990; 15: 1021–31.PubMedCrossRefGoogle Scholar
  21. 21.
    Berry JJ, Baker JA, Pieper KS, Hanson MW, Hoffman JM, Coleman RE. The effect of metabolic milieu on cardiac PET imaging using fluorine-18-deoxyglucose and nitrogen-13-ammonia in normal volunteers. J Nucl Med 1991; 32: 1518–25.PubMedGoogle Scholar
  22. 22.
    Knuuti MJ, Nuutila P, U. R, et al. Euglycemic hyperinsulinemic clamp and oral glucose load in stimulating myocardial glucose utilization during positron emission tomography. J Nucl Med 1992; 33: 1255–62.PubMedGoogle Scholar
  23. 23.
    vom Dahl J, Herman WH, Hicks RJ, et al. Myocardial glucose uptake in patients with insulin-dependent diabetes mellitus assessed quantitatively by dynamic positron emission tomography. Circulation 1993; 88: 395–404.Google Scholar
  24. 24.
    Schelbert HR. Euglycemic hyperinsulinemic clamp and oral glucose load in stimulating myocardial glucose utilization during positron emission tomography. J Nucl Med 1992; 33: 1263–66.PubMedGoogle Scholar
  25. 25.
    Tamaki N. Myocardial FDG PET studies with the fasting, oral glucose-loading or insulin clamp methods. J Nucl Med 1992; 33: 1263–1268.PubMedGoogle Scholar
  26. 26.
    Hicks RJ, Herman WH, Kalff V, et al. Quantitative evaluation of regional substrate metabolism in the human heart by positron emission tomography. J Am Coll Cardiol 1991; 18: 101–11.PubMedCrossRefGoogle Scholar
  27. 27.
    Gropler RJ, SiegEl BA, Lee KJ, et al. Nonuniformity in myocardial accumulation of F-18 fluorodeoxyglucose in normal fasted humans. J Nucl Med 1990; 31 (11): 174–956.Google Scholar
  28. 28.
    Knuuti MJ, Saraste M, Nuutila P, et al. Myocardial viability: fluorine-18deoxyglucose positron emission tomography in prediction of wall motion recovery after revascularization. Am Heart J 1994; 127: 785–96.PubMedCrossRefGoogle Scholar
  29. 29.
    Altehoefer C, vom Dahl J, Biedermann M, et al. Significance of defect severity in Technetium-99m-MIBI SPECT at rest to assess myocardial viability: comparison with Fluorine-18-FDG PET. J Nucl Med 1994; 35: 569–74.PubMedGoogle Scholar
  30. 30.
    Iida H, Rhodes CG,, de Silva R et al. Myocardial tissue fraction: correction for partial volume effects and measure of tissue viability. J Nucl Med 1991; 32: 216–975.Google Scholar
  31. 31.
    Yamamoto Y,, de Silva R, Rhodes CG et al. A new strategy for the assessment of viable myocardium and regional blood flow using 0–15 water and dynamic positron emission tomography. Circulation 1992; 86: 167–78.PubMedGoogle Scholar
  32. 32.
    de Silva R, Yamamoto Y, Rhodes C, et al. Preoperative prediction of the outcome of coronary revascularization using positron emission tomography. Circulation 1992; 86: 1738–42.PubMedGoogle Scholar
  33. 33.
    Gewirtz H, Fischman AJ, Abraham S, Gilson M, Strauss HW, Alpert NM. Positron emission tomographic measurements of absolute regional myocardial blood flow permits identification of nonviable myocardium in patients with chronic myocardial infarction. J Am Coll Cardiol 1994; 23: 851–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Goldstein R. Kinetics of Rubidium-82 after coronary occlusion and reperfusion. Assessment of patency and viability in open-chested dogs. J Clin Invest 1985; 75: 1131–7.CrossRefGoogle Scholar
  35. 35.
    Goldstein RA. Rubidium-82 kinetics after coronary occlusion: Temporal relation of net myocardial accumulation and viability in open-chested dogs. J Nucl Med 1986; 27: 1456–1461.PubMedGoogle Scholar
  36. 36.
    Gould KL, Yoshida K, Hess MJ, Haynie M, Mullani N, Smalling RW. Myocardial metabolism of fluorodeoxyglucose compared to cell membrane integrity for the potassium analogue rubidium-82 for assessing infarct size in man by PET. J Nucl Med 1991; 32: 1–9.PubMedGoogle Scholar
  37. 37.
    Yoshida K, Gould KL. Quantitative relation of myocardial infarct size and myocardial viability by positron emission tomography to left ventricular ejection fraction and 3-year mortality with and without revascularization. J Am Coll Cardiol 1993; 22: 984–97.PubMedCrossRefGoogle Scholar
  38. 38.
    vom Dahl J, Muzik O, Wolfe ER, Schwaiger M. Rubidium 82 kinetics assessed by positron emission tomography for characterization of myocardial viability (abstr). J Am Coll Cardiol 1992; 19: 142A.Google Scholar
  39. 39.
    Brown MA, Myears DW, Bergmann SR. Noninvasive assessment of canine myocardial oxidative metabolism with carbon-11 acetate and positron emission tomography. J Am Coll Cardiol 1988; 12: 1054–1063.PubMedCrossRefGoogle Scholar
  40. 40.
    Armbrecht JJ, Buxton DB, Schelbert HR. Validation of (1–11C] acetate as a tracer for noninvasive assessment of oxidative metabolism with positron emission tomography in normal, ischemic, postischemic, and hyperemic canine myocardium. Circulation 1990; 81: 1594–1605.PubMedCrossRefGoogle Scholar
  41. 41.
    Henes CG, Bergmann SR, Walsh MN, Sobel BE, Geitman EM. Assessment of myocardial oxidative metabolic reserve with positron emission tomography and carbon-11 acetate. J Nucl Med 1989; 30: 1489–99.PubMedGoogle Scholar
  42. 42.
    Henes CG, Bergmann SR, Perez JE, Sobel BE, Geitman EM. The time course of restoration of nutritive perfusion, myocardial oxygen consumption, and regional function after coronary thrombolysis. Coronary Artery Dis 1990; 1: 687–96.CrossRefGoogle Scholar
  43. 43.
    Gropler RJ, Geltman EM, Sampathkumaran K, et al. Functional recovery after coronary revascularization for chronic coronary artery disease is dependent on maintenance of oxidative metabolism. J Am Coll Cardiol 1992; 20: 569–77.PubMedCrossRefGoogle Scholar
  44. 44.
    Gropler RJ, Siegel BA, Sampathkumaran K, et al. Dependence of recovery of contractile function on maintenance of oxidative metabolism after myocardial infarction. J Am Coll Cardiol 1992; 19: 989–97.PubMedCrossRefGoogle Scholar
  45. 45.
    Lucignani G, Paolini G, Landoni C, et al. Presurgical identification of hibernating myocardium by combined use of technetium-99m hexakis 2methoxyisobutylisonitrile single photon emission tomography and fluorine-18 fluoro-2-deoxy-D-glucose positron emission tomography in patients with coronary artery disease. Eur J Nucl Med 1992; 19: 874–81.PubMedCrossRefGoogle Scholar
  46. 46.
    vom Dahl J, Altehoefer C, Sheehan FH, et al. Myocardial viability assessed by combined imaging using myocardial scintigraphy and positron emission tomography: impact on treatment and functional outcome following revascularization (abstr). J Am Coll Cardiol 1994; 23 (Suppl): 117A.CrossRefGoogle Scholar
  47. 47.
    Tamaki N. Current status of viability assessment with positron emission tomography. J Nucl Cardiol 1994; 1: 40–7.CrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1996

Authors and Affiliations

  • Juergen vom Dahl

There are no affiliations available

Personalised recommendations