Assessment of Myocardial Viability by Cardiovascular Magnetic Resonance

Abstract

Patients with ischemic heart disease may have left ventricular (LV) dysfunction due to reversible or irreversible causes. The ability to distinguish viable myocardium with dysfunction due to a reversible etiology (hibernation, stunning) from nonviable scar is critical for determining proper management of the patient. Cardiovascular magnetic resonance (CMR) is a technique that has been established to be useful for the detection of myocardial viability and advancements in the field promise to further increase its utility. In this review we describe the features of CMR that make it suited for this purpose and outline promising developments that may soon make CMR the reference standard for viability assessment.

Three-Dimensional Phase-Sensitive Inversion-Recovery Turbo FLASH Sequence for the Evaluation of Left Ventricular Myocardial Scar

“…T he assessment of myocardial viability with MRI using late gadolinium enhancement techniques is well established for the detection and characterization of myocardial scar in patients with ischemic cardiomyopathy [1][2][3]. Accurate assessment of the degree of infarct transmurality has been shown to be a predictive indicator for prognosis and restoration of contractile function after revascularization [4][5][6].…”

Assessment of left ventricular myocardial scar in infiltrative and non-ischemic cardiac diseases by free breathing three dimensional phase sensitive inversion recovery (PSIR) TurboFLASH

“…Increasingly, late gadolinium enhancement is being used for the assessment of non-ischemic cardiomyopathies as it allows differentiation of different diagnoses based on different patterns and location of late gadolinium enhancement [3]. Infiltrative myocardial disease and non-ischemic inflammatory cardiomyopathy demonstrate atypical patterns of enhancement on LGE-cMRI [4] in that they are typically not related to a coronary artery territory and often show a diffuse or patchy hyperenhanced pattern throughout the myocardium.…”

Use of cardiac magnetic resonance imaging in surgical ventricular restoration

“…The use of cardiac MRI to assess myocardial viability has been recently reviewed [2]. MRI has advantages over the more commonly used methods of viability assessment, such as nuclear scintigraphy using Thallium redistribution properties, glucose analog uptake using 18 Fluoro-deoxyglucose (FDG)-PET imaging, or functional imaging using dobutamine or exercise echocardiography.…”

“…Several imaging methods are now used to determine myocardial viability and plan treatment strategies, including echocardiography, single-photon emission computed tomography (SPECT) or positron emission tomography (PET) nuclear scintigraphy, and magnetic resonance imaging (MRI). Of these, MRI offers certain inherent advantages over the other methods [2]; currently, the main drawbacks of cardiac MRI are (a) its lack of widespread availability; (b) a small but nonnegligible fraction of patients with contraindications to MRI (e.g., claustrophobia, presence of implantable cardiac devices, etc. ); and (c) absence of a focus upon a scheme of specific measurements that can guide decision-making for cardiologists and surgeons in the diagnosis, operative planning, and follow-up intervals.…”