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Updated: Jun 15, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
The impact of viability assessment using myocardial perfusion imaging on patient management and outcome
Fadi G Hage1, Rajesh Venkataraman, Wael Aljaroudi
1Division of Cardiovascular Disease, University of Alabama at Birmingham, Zeigler Research Building 1024, 1530 3rd AVE S, Birmingham, AL 35294, USA. fadihage@uab.edu
Insights
Automated quantitative analysis of myocardial perfusion imaging (MPI) helps predict survival in ischemic cardiomyopathy (ICM) patients. Coronary revascularization (CR) improves survival, especially when nonviable myocardium is less than 20%.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- Ischemic cardiomyopathy (ICM) patients with viable myocardium benefit from coronary revascularization (CR) over medical therapy (MT).
- Myocardial perfusion imaging (MPI) is often assessed visually, but automated quantitative analysis may offer more precise insights.
- This study investigates the utility of automated quantitative MPI for guiding ICM management and predicting patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of automated quantitative viability analysis in myocardial perfusion imaging (MPI) for predicting survival in ischemic cardiomyopathy (ICM) patients.
- To compare the outcomes of coronary revascularization (CR) versus medical therapy (MT) in ICM patients based on quantitative MPI findings.
- To identify predictors of CR versus MT in ICM patients using automated quantitative MPI data.
Main Methods:
- 246 consecutive ICM patients undergoing rest-redistribution gated SPECT thallium-201 MPI were analyzed.
- Automated methods quantified perfusion defect size, redistribution, and nonviable myocardium (<50% activity).
- Mortality data was collected via the social security death index; follow-up averaged 41 months.
Main Results:
- 37% of patients underwent CR within 3 months. Independent predictors for CR included chest pain and transient ischemic dilatation.
- Overall survival was significantly better with CR than MT (P < .0001).
- For CR patients, smaller areas of nonviable myocardium (<20% LV) were associated with better survival, a benefit not observed in MT patients.
Conclusions:
- Automated quantitative MPI analysis is a valuable tool for predicting survival in ICM patients.
- The decision for CR versus MT is multifactorial, with "viability testing" being one important component.
- Quantitative MPI data, particularly the extent of nonviable myocardium, can inform treatment decisions and prognostication in ICM.
Background:
Prior studies show that ischemic cardiomyopathy (ICM) patients with substantial viable myocardium have better survival with coronary revascularization (CR) than medical therapy (MT). When myocardial perfusion imaging (MPI) is used, the analysis is often based on visual scoring. We sought to determine the value of automated quantitative viability analysis in guiding management and predicting outcome.
Methods:
We identified 246 consecutive ICM patients who had rest-redistribution gated SPECT thallium-201 MPI. Size and severity of perfusion defects were assessed by automated method. Regions with <50% activity vs normal were considered nonviable. Mortality was verified against the social security death index database.
Results:
Of the 246 patients, 37% underwent CR within 3 months of MPI. The initial images showed a total perfusion defect size of 32 +/- 17%, redistribution of 3.5 +/- 4.6% and nonviable myocardium of 13 +/- 14%LV. Using multivariate logistic regression analysis, independent predictors of CR included chest pains (OR 2.74) and rest-delayed transient ischemic dilatation (OR 4.49), while a prior history of CR or ventricular arrhythmias favored MT. The cohort was followed-up for 41 +/- 30 m during which 111 patients (45%) died. Survival was better with CR than MT (P < .0001). For CR, survival was better for those with a smaller area of nonviable myocardium (risk of death increased by 5%/1% increase in size of nonviable myocardium, P = .009) but this was not seen in MT. CR had a mortality advantage over MT when the area of nonviable myocardium was
Conclusions:
Automated quantitative analysis of MPI is useful in predicting survival in ICM, but the decision for or against CR is a complex one as it depends on multiple other factors and "viability testing" is just one variable that needs to be incorporated in the decision-making process.
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