https://link.springer.com/content/pdf/10.1007%2Fs12350-012-9605-y.pdf

Prognosis in the era of comparative effectiveness research: where is nuclear cardiology now and where should it be?

A 65-year-old man presented to his local emergency department with rapid atrial fibrillation and acute pulmonary edema. This patient had a history of hypertension, and 2 months before this presentation, he developed progressive exertional dyspnea. The patient deteriorated in the emergency department and went into cardiogenic shock. Emergent coronary angiography revealed diffuse 3-vessel disease: a 99% proximal left anterior descending coronary artery lesion, 90% mid-right coronary artery lesion, occluded large first marginal branch, and diffuse severe disease of the left circumflex coronary artery. The initial ejection fraction (EF) on echocardiography was 15%, with mild mitral regurgitation and an estimated pulmonary artery pressure of 55 mm Hg. The patient stabilized with an intraaortic balloon pump and intensive care unit management; however, because of the diffuse nature of the disease, he was not believed to be a surgical candidate. He was transferred to another tertiary-care facility for consideration of cardiac transplantation. As part of this evaluation, a PET viability study was done that demonstrated a significant area of perfusion-metabolism mismatch in the entire anteriolateral wall. Less than 1% of the myocardium was scar, and 28% was defined as hibernating (Figure 1).



Figure 1. 
A rest rubidium 82 and 18F-fluorodeoxyglucose (FDG) PET viability imaging study in corresponding short-axis, horizontal long-axis, and vertical long-axis slices. Perfusion images demonstrate a moderate to severe reduction in perfusion defect in the entire anterior wall, anterolateral wall, and apex. The lateral wall also has a moderate to severe perfusion defect. The FDG images (second row) demonstrate FDG uptake in the anterior wall extending to the apex and lateral wall, corresponding to a total scar score of 0.54% and a mismatch score of 26% of the ventricular myocardium.



Response by Velazquez on p 270

The results of the viability test were pivotal in the decision to perform coronary artery …

Does imaging-guided selection of patients with ischemic heart failure for high risk revascularization improve identification of those with the highest clinical benefit?: Imaging-guided selection of patients with ischemic heart failure for high-risk revascularization improves identification of those with the highest clinical benefit.

Ischemic heart failure is a growing disease with high morbidity and mortality. Several studies suggest the benefit of viability imaging to assist revascularization decision, but there is controversy. Multiple imaging modalities can be used to accurately define hibernating myocardium; however, the best approach remains uncertain. This review will highlight current evidence and future directions of viability imaging assessment.

/pdf/myocardial-viability-from-parr-2-to-image-hf-current-4mgv95e50f.pdf

Myocardial Viability: From PARR-2 to IMAGE HF - Current Evidence and Future Directions

Introduction: Coronary artery disease commonly leads to myocardial ischaemia and hibernation. Relevant preclinical models of these conditions are essential to evaluate new therapeutic options such as cell-based vasculogenic therapies. Areas covered: In this article, the authors first review basic concepts of myocardial ischaemia/hibernation and relevant techniques to assess myocardial viability. Then, preclinical models of chronic myocardial ischaemia and hibernation, induced by devices such as ameroid constrictors, Delrin stenosis, hydraulic occluders, and coils/stents are described. Lastly, the authors discuss cell-based vasculogenic therapy, and summarise studies conducted in large animal models of chronic myocardial ischaemia and hibernation. Expert opinion: Approximately one-third of patients with viable myocardium do not undergo revascularisation; however, this population is at high risk for cardiac events and would surely benefit from effective cell-based therapy. Because of the modest benefits in ...

Cell-based vasculogenic studies in preclinical models of chronic myocardial ischaemia and hibernation.

Prognostic value of positron emission tomography myocardial perfusion imaging beyond traditional cardiovascular risk factors: Systematic review and meta-analysis

Background: Patientswithleftventriculardysfunctionwhosemanagement is directed by F-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging may have a quality of life (QOL) benefit over standard care. Methods: Among 430 patients randomized in the PET and Recovery Following Revascularization (PARR)-2 trial to FDG PET-assisted management vs standard, QOL scores were obtained using the European Quality of Life-5 Dimensions (EQ-5D) in 427 patients at baseline (FDG

https://www.onlinecjc.ca/article/S0828-282X(11)01286-4/pdf

Clinical Research Does FDG PET-Assisted Management of Patients With Left Ventricular Dysfunction Improve Quality of Life? A Substudy of the PARR-2 Trial

https://pubs.rsna.org/doi/pdf/10.1148/radiol.14140269

s ex-based Prognostic implications of nonobstructive coronary artery Disease: Results from the International Multicenter

Prognostic significance of resting blood pressure and blood pressure response during vasodilator stress rb-82 positron emission tomography myocardial perfusion imaging

Quantification of coronary artery calcium using low-dose PET-CT attenuation correction scan

Obesity is a significant health problem that could potentially lead to increased cardiovascular risk Noninvasive imaging plays an important role in the evaluation of cardiovascular symptoms and risk of these patients Selection of the appropriate test in the diagnosis of obstructive coronary artery disease in this unique population is important In this article, we focus on the strengths, limitations, and recommendations of the various noninvasive cardiac imaging modalities available in the detection of obstructive coronary artery disease We have suggested an algorithm to help direct investigation Ultimately, patient management should be individualized based on clinical judgement, test availability, and local expertise RESUME

https://www.onlinecjc.ca/article/S0828-282X(14)01650-X/pdf

Training/Practice Contemporary Issues in Cardiology Practice Obesity and the Challenges of Noninvasive Imaging for the Detection of Coronary Artery Disease

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