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01.04.2015 | Review Article | Ausgabe 2/2015 Open Access

Journal of Nuclear Cardiology 2/2015

Myocardial viability as integral part of the diagnostic and therapeutic approach to ischemic heart failure

Journal of Nuclear Cardiology > Ausgabe 2/2015
MD, PhD Jeroen J. Bax, MD, PhD Victoria Delgado
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s12350-015-0096-5) contains supplementary material, which is available to authorized users.


Chronic heart failure is a major public-health problem with a high prevalence, complex treatment, and high mortality. A careful and comprehensive analysis is needed to provide optimal (and personalized) therapy to heart failure patients. The main 4 non-invasive imaging techniques (echocardiography, magnetic resonance imaging, multi-detector-computed tomography, and nuclear imaging) provide information on cardiovascular anatomy and function, which form the basis of the assessment of the pathophysiology underlying heart failure. The selection of imaging modalities depends on the information that is needed for the clinical management of the patients: (1) underlying etiology (ischemic vs non-ischemic); (2) in ischemic patients, need for revascularization should be evaluated (myocardial ischemia/viability?); (3) left ventricular function and shape assessment; (4) presence of significant secondary mitral regurgitation; (5) device therapy with cardiac resynchronization therapy and/or implantable cardiac defibrillator (risk of sudden cardiac death). This review is dedicated to assessment of myocardial viability, however “isolated assessment of myocardial viability” may be clinically not meaningful and should be considered among all those different variables. This complete information will enable personalized treatment of the patient with ischemic heart failure.

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Video 1
Assessment of left ventricular systolic function. Panel A: 2-dimensional transthoracic echocardiography showing an apical 4-chamber view with reduced left ventricular ejection fraction. Panel B: Contrast-enhanced 3-dimensional triplane apical view of the left ventricle. Panel C: ECG-gated single-photon emission-computed tomography of the left ventricle showing apical dyskinesia. Panel D: assessment of left ventricular systolic function with multi-detector row computed tomography. Panel E: Cine magnetic resonance imaging showing the reconstructed 4-chamber view. The left ventricle is dilated, with reduced left ventricular ejection fraction and large thin-walled apical aneurysm (WMV 8802 kb)
Video 2
Evaluation of secondary mitral regurgitation. Panel A: 2-dimensional transthoracic color Doppler echocardiography showing the apical 4-chamber view and severe secondary mitral regurgitation with large eccentric jet along the lateral wall of the left atrium. Panel B: 2-dimensional transesophageal echocardiography showing the 4-chamber view focused on the mitral valve which shows restriction of the posterior mitral leaflet (arrow) and lack of coaptation. Panel C: 2-dimensional transesophageal color Doppler echocardiography showing the resultant severe secondary mitral regurgitation. Panel D: 3-dimensional full volume en-face view of the mitral valve showing a large area of lack of coaptation of the mitral leaflets. Panel E: On 3-dimensional transesophageal color Doppler echocardiography data, the multiplanar reformations can be oriented across the vena contracta of the regurgitant jet showing the elliptic shape of the regurgitant orifice (WMV 11693 kb)
Case 1. Figure 1 : Contrast-enhanced magnetic resonance imaging showing selected 2-chamber and short-axis views of the left ventricle. The dilated left ventricle revealed subendocardial scar (<10% transmurality) in the mid anterior and inferior walls (arrows) (TIFF 1256 kb)
Case 1. Video 1 2-dimensional transthoracic echocardiography showing the apical left ventricular 4-, 2- and 3-chamber views. The left ventricular ejection fraction was 22% (WMV 18966 kb)
Case 1. Video 2 Invasive coronary angiography showing severe stenosis of the proximal segments of the left anterior descending and circumflex coronary arteries (panel A) and chronically occluded right coronary artery (panel B) (WMV 12888 kb)
Case 1. Video 3 Cine magnetic resonance imaging showing the 4- and 2-chamber long-axis and the short-axis views of the left ventricle. The left ventricle is significantly dilated and shows global hypokinesia but no significant wall thinning (WMV 5990 kb)
Case 1. Video 4 Low-dose dobutamine stress echocardiography showing the apical 4-, 2- and 3-chamber views of the left ventricle. The left ventricular function and wall thickening improved at low-dose dobutamine (WMV 9670 kb)
Case 1. Video 5 After surgical revascularization, significant left ventricular reverse remodeling was observed with subsequent improvement in systolic function. Apical left ventricular 4-, 2- and 3-chamber views are shown (WMV 16591 kb)
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