Myocardial perfusion imaging in ischemic heart disease anno 1990

The field of radionuclide myocardial perfusion imaging is in a rapid state of change. Stress-rest myocardial imaging is important not only for the detection of coronary artery disease but also for prognostic stratification of patients. In particular, assessment of myocardial viability in patients with left ventricular dysfunction is a recent focus of investigation. Single-photon emission computed tomography has become widely accepted as the preferred (albeit challenging) imaging modality for myocardial perfusion imaging. Silent myocardial ischemia and its clinical significance continues to be an intriguing aspect of the clinical manifestation of coronary artery disease. Myocardial perfusion imaging is an invaluable independent method to unravel this problem. Dipyridamole was approved for pharmacologic vasodilation in conjunction with myocardial perfusion imaging. At the same time, direct infusion of adenosine was proposed as an alternative method of effecting vasodilatory stress. In 1990, several new technetium-99m-labeled myocardial perfusion imaging agents have been introduced (teboroxime and hexakis-2-methoxyisobutyl-isonitrile [sestaMIBI]) that may have a profound impact on imaging techniques and applications of myocardial perfusion imaging.