Noninvasive assessment myocardial viability: current status and future directions
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Updated: May 10, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
1Department of PET and Nuclear Medicine, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia. kallman@nucmed.rpa.cs.nsw.gov.au
Insights
Myocardial viability, the reversibility of cardiac contractile dysfunction in coronary artery disease, is assessed using advanced imaging. Techniques like PET and cardiac MRI are crucial for understanding and managing this condition.
Area of Science:
- Cardiology
- Medical Imaging
- Nuclear Medicine
Background:
- Cardiac contractile dysfunction in coronary artery disease (CAD) and ischemia can be reversible.
- Over 40 years of research has elucidated the mechanisms and clinical relevance of myocardial viability.
- Advances in imaging have significantly improved our understanding of this phenomenon.
Purpose of the Study:
- To review the evolution and current state of myocardial viability assessment in CAD patients.
- To discuss various imaging techniques, their data, and clinical trial outcomes.
- To explore challenges and future directions, including combined PET/CMR imaging.
Main Methods:
- Review of historical observations and accumulated basic science and clinical data.
- Analysis of advancements in cardiac imaging: SPECT, PET (F-18 FDG, N-13 ammonia, Rb-82 Cl), stress echocardiography, and cardiac magnetic resonance imaging (CMR).
- Inclusion of data from observational studies, meta-analyses, and clinical trials.
Main Results:
- Multiple imaging modalities, including SPECT, PET, stress echocardiography, and CMR, have been developed and refined for viability assessment.
- Pooled observational data and clinical trials demonstrate the clinical relevance of myocardial viability.
- Emerging techniques like combined PET/CMR imaging show potential for enhanced assessment.
Conclusions:
- Myocardial viability assessment has evolved significantly, driven by technological advancements in cardiac imaging.
- Accurate assessment of myocardial viability is critical for guiding treatment decisions in patients with CAD.
- Future research should focus on refining existing techniques and exploring novel combined imaging approaches for improved patient outcomes.
Abstract:
Observations of reversibility of cardiac contractile dysfunction in patients with coronary artery disease and ischemia were first made more than 40 years ago. Since that time a wealth of basic science and clinical data has been gathered exploring the mechanisms of this phenomenon of myocardial viability and relevance to clinical care of patients. Advances in cardiac imaging techniques have contributed greatly to knowledge in the area, first with thallium-201 imaging, then later with Tc-99m-based tracers for SPECT imaging and metabolic tracers used in conjunction with positron emission tomography (PET), most commonly F-18 FDG in conjunction with blood flow imaging with N-13 ammonia or Rb-82 Cl. In parallel, stress echocardiography has made great progress also. Over time observational studies in patients using these techniques accumulated and were later summarized in several meta-analyses. More recently, cardiac magnetic resonance imaging (CMR) has contributed further information in combination with either late gadolinium enhancement imaging or dobutamine stress. This review discusses the tracer and CMR imaging techniques, the pooled observational data, the results of clinical trials, and ongoing investigation in the field. It also examines some of the current challenges and issues for researchers and explores the emerging potential of combined PET/CMR imaging for myocardial viability.
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