[Post-infarction myocardial viability. Role of scintigraphic evaluation]

Myocardial scintigraphy is clinically relevant in the management of patients with previous myocardial infarction. The purpose of such investigation is first to quantify the infarcted area, secondly to detect and quantify a residual myocardial ischaemia and thirdly to evidence the presence of chronically hypoperfused and akinetic but potentially viable myocardium (hibernating myocardium). Thallium SPECT is to be preferred in this indication even if new tracers could be promising: fatty acids, 18Fluorodesoxyglucose imaged by PET or SPECT cameras. In such indications, stress tests should sometimes be completed with delayed or rest acquisitions. In case of negative stress and rest thallium SPECT, PET scans may be useful in patients with large myocardial infarction, severe left ventricular dysfunction, segmental wall motion asynergy, and absence of previously demonstrated residual ischaemia in order to select patients eligible for coronary revascularization or heart transplantation.