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2012 | OriginalPaper | Hoofdstuk

4. Nuclear Imaging in Ischemic Heart Disease

Auteurs : Sharmila Dorbala, MBBS, FACC, Marcelo F. Di Carli, MD, FACC

Uitgeverij: Springer US

Abstract

Ischemic heart disease is one of the major causes of mortality and morbidity in men and women accounting for 34.3% (1 of every 2.9) deaths in the US in 2006 [1]. Noninvasive imaging techniques of echocardiography, nuclear imaging, cardiac CT, and cardiac magnetic resonance imaging have played a major role in the evaluation and management of patients with ischemic heart disease. This chapter will focus on the role of nuclear imaging techniques in the evaluation of ischemic heart disease. We will discuss the clinical applications of the most commonly used nuclear imaging techniques of single-photon emission computed tomography (SPECT) and positron emission tomography (PET) in the evaluation of patients with known or suspected stable coronary artery disease (CAD), acute chest pain and acute coronary syndromes (ACS) (NSTEMI and STEMI), and chronic heart failure.

vorige hoofdstuk Echocardiographic Evaluation of Ischemic Heart Disease

volgende hoofdstuk Noninvasive Coronary Artery Imaging with CT and MRI

Lloyd-Jones D, Adams RJ, Brown TM, et al. Heart disease and stroke statistics – 2010 update: a report from the American Heart Association. Circulation. 2010;121:e46–215.PubMedCrossRef

Klocke FJ, Baird MG, Lorell BH, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging–executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). J Am Coll Cardiol. 2003;42:1318–33.PubMedCrossRef

Rozanski A, Diamond GA, Berman D, Forrester JS, Morris D, Swan HJ. The declining specificity of exercise radionuclide ventriculography. N Engl J Med. 1983;309:518–22.PubMedCrossRef

DePuey EG, Rozanski A. Using gated technetium-99m-sestamibi SPECT to characterize fixed myocardial defects as infarct or artifact. J Nucl Med. 1995;36:952–5.PubMed

Ficaro EP, Fessler JA, Shreve PD, Kritzman JN, Rose PA, Corbett JR. Simultaneous transmission/emission myocardial perfusion tomography. Diagnostic accuracy of attenuation-corrected 99mTc-sestamibi single-photon emission computed tomography. Circulation. 1996;93:463–73.PubMedCrossRef

Hendel RC, Berman DS, Cullom SJ, et al. Multicenter clinical trial to evaluate the efficacy of correction for photon attenuation and scatter in SPECT myocardial perfusion imaging. Circulation. 1999;99:2742–9.PubMedCrossRef

Kluge R, Sattler B, Seese A, Knapp WH. Attenuation correction by simultaneous emission-transmission myocardial single-photon emission tomography using a technetium-99m-labelled radiotracer: impact on diagnostic accuracy. Eur J Nucl Med. 1997;24:1107–14.PubMed

Links JM, DePuey EG, Taillefer R, Becker LC. Attenuation correction and gating synergistically improve the diagnostic accuracy of myocardial perfusion SPECT. J Nucl Cardiol. 2002;9:183–7.PubMedCrossRef

Fricke E, Fricke H, Weise R, et al. Attenuation correction of myocardial SPECT perfusion images with low-dose CT: evaluation of the method by comparison with perfusion PET. J Nucl Med. 2005;46:736–44.PubMed

10.

Masood Y, Liu YH, Depuey G, et al. Clinical validation of SPECT attenuation correction using x-ray computed tomography-derived attenuation maps: multicenter clinical trial with angiographic correlation. J Nucl Cardiol. 2005;12:676–86.PubMedCrossRef

11.

Sharir T, Slomka PJ, Hayes SW, et al. Multicenter trial of high-speed versus conventional single-photon emission computed tomography imaging: quantitative results of myocardial perfusion and left ventricular function. J Am Coll Cardiol. 2010;55:1965–74.PubMedCrossRef

12.

Einstein AJ, Moser KW, Thompson RC, Cerqueira MD, Henzlova MJ. Radiation dose to patients from cardiac diagnostic imaging. Circulation. 2007;116:1290–305.PubMedCrossRef

13.

Heller GV, Bateman TM, Johnson LL, et al. Clinical value of attenuation correction in stress-only Tc-99m sestamibi SPECT imaging. J Nucl Cardiol. 2004;11:273–81.PubMedCrossRef

14.

Bateman TM, Heller GV, McGhie AI, et al. Multicenter investigation comparing a highly efficient half-time stress-only attenuation correction approach against standard rest-stress Tc-99m SPECT imaging. J Nucl Cardiol. 2009;16:726–35.PubMedCrossRef

15.

Chang SM, Nabi F, Xu J, Raza U, Mahmarian JJ. Normal stress-only versus standard stress/rest myocardial perfusion imaging: similar patient mortality with reduced radiation exposure. J Am Coll Cardiol. 2010;55:221–30.PubMedCrossRef

16.

Duvall WL, Wijetunga MN, Klein TM, et al. The prognosis of a normal stress-only Tc-99m myocardial perfusion imaging study. J Nucl Cardiol. 2010;17:370–7.PubMedCrossRef

17.

Al-Mallah MH, Sitek A, Moore SC, Di Carli M, Dorbala S. Assessment of myocardial perfusion and function with PET and PET/CT. J Nucl Cardiol. 2010;17:498–513.PubMedCrossRef

18.

Di Carli MF, Dorbala S, Meserve J, El Fakhri G, Sitek A, Moore SC. Clinical myocardial perfusion PET/CT. J Nucl Med. 2007;48:783–93.PubMedCrossRef

19.

Di Carli MF, Hachamovitch R. New technology for noninvasive evaluation of coronary artery disease. Circulation. 2007;115:1464–80.PubMedCrossRef

20.

Heller GV, Calnon D, Dorbala S. Recent advances in cardiac PET and PET/CT myocardial perfusion imaging. J Nucl Cardiol. 2009;16:962–9.PubMedCrossRef

21.

Nekolla SG, Reder S, Saraste A, et al. Evaluation of the novel myocardial perfusion positron-emission tomography tracer 18F-BMS-747158-02: comparison to 13N-ammonia and validation with microspheres in a pig model. Circulation. 2009;119:2333–42.PubMedCrossRef

22.

Bateman TM, Heller GV, McGhie AI, et al. Diagnostic accuracy of rest/stress ECG-gated Rb-82 myocardial perfusion PET: comparison with ECG-gated Tc-99m sestamibi SPECT. J Nucl Cardiol. 2006;13:24–33.PubMedCrossRef

23.

Sampson UK, Dorbala S, Limaye A, Kwong R, Di Carli MF. Diagnostic accuracy of rubidium-82 myocardial perfusion imaging with hybrid positron emission tomography/computed tomography in the detection of coronary artery disease. J Am Coll Cardiol. 2007;49:1052–8.PubMedCrossRef

24.

Di Carli MF, Bianco-Batlles D, Landa ME, et al. Effects of autonomic neuropathy on coronary blood flow in patients with diabetes mellitus. Circulation. 1999;100:813–9.PubMedCrossRef

25.

Pitkanen OP, Raitakari OT, Niinikoski H, et al. Coronary flow reserve is impaired in young men with familial hypercholesterolemia. J Am Coll Cardiol. 1996;28:1705–11.PubMedCrossRef

26.

Czernin J, Sun K, Brunken R, Bottcher M, Phelps M, Schelbert H. Effect of acute and long-term smoking on myocardial blood flow and flow reserve. Circulation. 1995;91:2891–7.PubMedCrossRef

27.

Dayanikli F, Grambow D, Muzik O, Mosca L, Rubenfire M, Schwaiger M. Early detection of abnormal coronary flow reserve in asymptomatic men at high risk for coronary artery disease using positron emission tomography. Circulation. 1994;90:808–17.PubMedCrossRef

28.

Camici PG, Crea F. Coronary microvascular dysfunction. N Engl J Med. 2007;356:830–40.PubMedCrossRef

29.

Campisi R, Di Carli MF. Assessment of coronary flow reserve and microcirculation: a clinical perspective. J Nucl Cardiol. 2004;11:3–11.PubMedCrossRef

30.

Neglia D, Michelassi C, Trivieri MG, et al. Prognostic role of myocardial blood flow impairment in idiopathic left ventricular dysfunction. Circulation. 2002;105:186–93.PubMedCrossRef

31.

Cecchi F, Olivotto I, Gistri R, Lorenzoni R, Chiriatti G, Camici PG. Coronary microvascular dysfunction and prognosis in hypertrophic cardiomyopathy. N Engl J Med. 2003;349:1027–35.PubMedCrossRef

32.

Ladenheim ML, Pollock BH, Rozanski A, et al. Extent and severity of myocardial hypoperfusion as predictors of prognosis in patients with suspected coronary artery disease. J Am Coll Cardiol. 1986;7:464–71.PubMedCrossRef

33.

Hachamovitch R, Berman DS, Shaw LJ, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation. 1998;97:535–43.PubMedCrossRef

34.

Dorbala S, Hachamovitch R, Curillova Z, et al. Incremental prognostic value of gated Rb-82 positron emission tomography myocardial perfusion imaging over clinical variables and rest LVEF. JACC Cardiovasc Imaging. 2009;2:846–54.PubMedCrossRef

35.

Hachamovitch R, Hayes S, Friedman JD, et al. Determinants of risk and its temporal variation in patients with normal stress myocardial perfusion scans: what is the warranty period of a normal scan? J Am Coll Cardiol. 2003;41:1329–40.PubMedCrossRef

36.

Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation. 2003;107:2900–7.PubMedCrossRef

37.

Boden WE, O’Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1503–16.PubMedCrossRef

38.

Shaw LJ, Berman DS, Maron DJ, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation. 2008;117:1283–91.PubMedCrossRef

39.

Anand DV, Lim E, Hopkins D, et al. Risk stratification in uncomplicated type 2 diabetes: prospective evaluation of the combined use of coronary artery calcium imaging and selective myocardial perfusion scintigraphy. Eur Heart J. 2006;27:713–21.PubMedCrossRef

40.

Berman DS, Wong ND, Gransar H, et al. Relationship between stress-induced myocardial ischemia and atherosclerosis measured by coronary calcium tomography. J Am Coll Cardiol. 2004;44:923–30.PubMedCrossRef

41.

He ZX, Hedrick TD, Pratt CM, et al. Severity of coronary artery calcification by electron beam computed tomography predicts silent myocardial ischemia. Circulation. 2000;101:244–51.PubMedCrossRef

42.

Schepis T, Gaemperli O, Koepfli P, et al. Added value of coronary artery calcium score as an adjunct to gated SPECT for the evaluation of coronary artery disease in an intermediate-risk population. J Nucl Med. 2007;48:1424–30.PubMedCrossRef

43.

Chang SM, Nabi F, Xu J, et al. The coronary artery calcium score and stress myocardial perfusion imaging provide independent and complementary prediction of cardiac risk. J Am Coll Cardiol. 2009;54:1872–82.PubMedCrossRef

44.

Uebleis C, Becker A, Griesshammer I, et al. Stable coronary artery disease: prognostic value of myocardial perfusion SPECT in relation to coronary calcium scoring – long-term follow-up. Radiology. 2009;252:682–90.PubMedCrossRef

45.

Wong ND, Detrano RC, Diamond G, et al. Does coronary artery screening by electron beam computed tomography motivate potentially beneficial lifestyle behaviors? Am J Cardiol. 1996;78:1220–3.PubMedCrossRef

46.

Blankstein R, Dorbala S. Adding calcium scoring to myocardial perfusion imaging: does it alter physicians’ therapeutic decision making? J Nucl Cardiol. 2010;17:168–71.PubMedCrossRef

47.

Bybee KA, Lee J, Markiewicz R, et al. Diagnostic and clinical benefit of combined coronary calcium and perfusion assessment in patients undergoing PET/CT myocardial perfusion stress imaging. J Nucl Cardiol. 2010;17:188–96.PubMedCrossRef

48.

Gould KL, Ornish D, Scherwitz L, et al. Changes in myocardial perfusion abnormalities by positron emission tomography after long-term, intense risk factor modification. JAMA. 1995;274:894–901.PubMedCrossRef

49.

Ornish D, Scherwitz LW, Billings JH, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998;280:2001–7.PubMedCrossRef

50.

Underwood SR, Godman B, Salyani S, Ogle JR, Ell PJ. Economics of myocardial perfusion imaging in Europe – the EMPIRE Study. Eur Heart J. 1999;20:157–66.PubMedCrossRef

51.

Shaw LJ, Hachamovitch R, Berman DS, et al. The economic consequences of available diagnostic and prognostic strategies for the evaluation of stable angina patients: an observational assessment of the value of precatheterization ischemia. Economics of Noninvasive Diagnosis (END) Multicenter Study Group. J Am Coll Cardiol. 1999;33:661–9.PubMedCrossRef

52.

Patterson RE, Eisner RL, Horowitz SF. Comparison of cost-effectiveness and utility of exercise ECG, single photon emission computed tomography, positron emission tomography, and coronary angiography for diagnosis of coronary artery disease. Circulation. 1995;91:54–65.PubMedCrossRef

53.

Merhige ME, Breen WJ, Shelton V, Houston T, D’Arcy BJ, Perna AF. Impact of myocardial perfusion imaging with PET and (82)Rb on downstream invasive procedure utilization, costs, and outcomes in coronary disease management. J Nucl Med. 2007;48:1069–76.PubMedCrossRef

54.

Hachamovitch R, Johnson JR, Hlatky MA, et al. The study of myocardial perfusion and coronary anatomy imaging roles in CAD (SPARC): design, rationale, and baseline patient characteristics of a prospective, multicenter observational registry comparing PET, SPECT, and CTA for resource utilization and clinical outcomes. J Nucl Cardiol. 2009;16:935–48.PubMedCrossRef

55.

Wackers FJ, Lie KI, Liem KL, et al. Potential value of thallium-201 scintigraphy as a means of selecting patients for the coronary care unit. Br Heart J. 1979;41:111–7.PubMedCrossRef

56.

Bilodeau L, Theroux P, Gregoire J, Gagnon D, Arsenault A. Technetium-99m sestamibi tomography in patients with spontaneous chest pain: correlations with clinical, electrocardiographic and angiographic findings. J Am Coll Cardiol. 1991;18:1684–91.PubMedCrossRef

57.

Christian TF, Clements IP, Gibbons RJ. Noninvasive identification of myocardium at risk in patients with acute myocardial infarction and nondiagnostic electrocardiograms with technetium-99m-Sestamibi. Circulation. 1991;83:1615–20.PubMedCrossRef

58.

Kontos MC, Jesse RL, Schmidt KL, Ornato JP, Tatum JL. Value of acute rest sestamibi perfusion imaging for evaluation of patients admitted to the emergency department with chest pain. J Am Coll Cardiol. 1997;30:976–82.PubMedCrossRef

59.

Kontos MC, Jesse RL, Anderson FP, Schmidt KL, Ornato JP, Tatum JL. Comparison of myocardial perfusion imaging and cardiac troponin I in patients admitted to the emergency department with chest pain. Circulation. 1999;99:2073–8.PubMedCrossRef

60.

Varetto T, Cantalupi D, Altieri A, Orlandi C. Emergency room technetium-99m sestamibi imaging to rule out acute myocardial ischemic events in patients with nondiagnostic electrocardiograms. J Am Coll Cardiol. 1993;22:1804–8.PubMedCrossRef

61.

Hilton TC, Thompson RC, Williams HJ, Saylors R, Fulmer H, Stowers SA. Technetium-99m sestamibi myocardial perfusion imaging in the emergency room evaluation of chest pain. J Am Coll Cardiol. 1994;23:1016–22.PubMedCrossRef

62.

Tatum JL, Jesse RL, Kontos MC, et al. Comprehensive strategy for the evaluation and triage of the chest pain patient. Ann Emerg Med. 1997;29:116–25.PubMedCrossRef

63.

Heller GV, Stowers SA, Hendel RC, et al. Clinical value of acute rest technetium-99m tetrofosmin tomographic myocardial perfusion imaging in patients with acute chest pain and nondiagnostic electrocardiograms. J Am Coll Cardiol. 1998;31:1011–7.PubMedCrossRef

64.

Stowers SA, Eisenstein EL, Th Wackers FJ, et al. An economic analysis of an aggressive diagnostic strategy with single photon emission computed tomography myocardial perfusion imaging and early exercise stress testing in emergency department patients who present with chest pain but nondiagnostic electrocardiograms: results from a randomized trial. Ann Emerg Med. 2000;35:17–25.PubMedCrossRef

65.

Udelson JE, Beshansky JR, Ballin DS, et al. Myocardial perfusion imaging for evaluation and triage of patients with suspected acute cardiac ischemia: a randomized controlled trial. JAMA. 2002;288:2693–700.PubMedCrossRef

66.

Hoffmann U, Bamberg F, Chae CU, et al. Coronary computed tomography angiography for early triage of patients with acute chest pain: the ROMICAT (Rule Out Myocardial Infarction using Computer Assisted Tomography) trial. J Am Coll Cardiol. 2009;53:1642–50.PubMedCrossRef

67.

Goldstein JA, Gallagher MJ, O’Neill WW, Ross MA, O’Neil BJ, Raff GL. A randomized controlled trial of multi-slice coronary computed tomography for evaluation of acute chest pain. J Am Coll Cardiol. 2007;49:863–71.PubMedCrossRef

68.

Dilsizian V, Bateman TM, Bergmann SR, et al. Metabolic imaging with beta-methyl-p-[(123)I]-iodophenyl-pentadecanoic acid identifies ischemic memory after demand ischemia. Circulation. 2005;112:2169–74.PubMedCrossRef

69.

Brown KA, Heller GV, Landin RS, et al. Early dipyridamole (99m)Tc-sestamibi single photon emission computed tomographic imaging 2 to 4 days after acute myocardial infarction predicts in-hospital and postdischarge cardiac events: comparison with submaximal exercise imaging. Circulation. 1999;100:2060–6.PubMedCrossRef

70.

Verani MS. Exercise and pharmacologic stress testing for prognosis after acute myocardial infarction. J Nucl Med. 1994;35:716–20.PubMed

71.

Gibson RS, Watson DD. Value of planar 201Tl imaging in risk stratification of patients recovering from acute myocardial infarction. Circulation. 1991;84:I148–62.PubMed

72.

Leppo JA, O’Brien J, Rothendler JA, Getchell JD, Lee VW. Dipyridamole-thallium-201 scintigraphy in the prediction of future cardiac events after acute myocardial infarction. N Engl J Med. 1984;310:1014–8.PubMedCrossRef

73.

Hendel RC, Berman DS, Di Carli MF, et al. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 appropriate use criteria for cardiac radionuclide imaging: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine. Circulation. 2009;119:e561–87.PubMedCrossRef

74.

Zaret BL, Wackers FJ, Terrin ML, et al. Value of radionuclide rest and exercise left ventricular ejection fraction in assessing survival of patients after thrombolytic therapy for acute myocardial infarction: results of thrombolysis in myocardial infarction (TIMI) phase II study. The TIMI Study Group. J Am Coll Cardiol. 1995;26:73–9.PubMedCrossRef

75.

Burns RJ, Gibbons RJ, Yi Q, et al. The relationships of left ventricular ejection fraction, end-systolic volume index and infarct size to six-month mortality after hospital discharge following myocardial infarction treated by thrombolysis. J Am Coll Cardiol. 2002;39:30–6.PubMedCrossRef

76.

Corbett JR, Dehmer GJ, Lewis SE, et al. The prognostic value of submaximal exercise testing with radionuclide ventriculography before hospital discharge in patients with recent myocardial infarction. Circulation. 1981;64:535–44.PubMedCrossRef

77.

Mahmarian JJ, Dakik HA, Filipchuk NG, et al. An initial strategy of intensive medical therapy is comparable to that of coronary revascularization for suppression of scintigraphic ischemia in high-risk but stable survivors of acute myocardial infarction. J Am Coll Cardiol. 2006;48:2458–67.PubMedCrossRef

78.

Mahmarian JJ, Shaw LJ, Filipchuk NG, et al. A multinational study to establish the value of early adenosine technetium-99m sestamibi myocardial perfusion imaging in identifying a low-risk group for early hospital discharge after acute myocardial infarction. J Am Coll Cardiol. 2006;48:2448–57.PubMedCrossRef

79.

Udelson JE, Coleman PS, Metherall J, et al. Predicting recovery of severe regional ventricular dysfunction. Comparison of resting scintigraphy with 201Tl and 99mTc-sestamibi. Circulation. 1994;89:2552–61.PubMedCrossRef

80.

Bonow RO, Dilsizian V, Cuocolo A, Bacharach SL. Identification of viable myocardium in patients with chronic coronary artery disease and left ventricular dysfunction. Comparison of thallium scintigraphy with reinjection and PET imaging with 18F-fluorodeoxyglucose. Circulation. 1991;83:26–37.PubMedCrossRef

81.

Tamaki N, Ohtani H, Yamashita K, et al. Metabolic activity in the areas of new fill-in after thallium-201 reinjection: comparison with positron emission tomography using fluorine-18-deoxyglucose. J Nucl Med. 1991;32:673–8.PubMed

82.

Sciagra R, Bisi G, Santoro GM, et al. Comparison of baseline-nitrate technetium-99m sestamibi with rest-redistribution thallium-201 tomography in detecting viable hibernating myocardium and predicting postrevascularization recovery. J Am Coll Cardiol. 1997;30:384–91.PubMedCrossRef

83.

Leoncini M, Marcucci G, Sciagra R, et al. Prediction of functional recovery in patients with chronic coronary artery disease and left ventricular dysfunction combining the evaluation of myocardial perfusion and of contractile reserve using nitrate-enhanced technetium-99m sestamibi gated single-photon emission computed tomography and dobutamine stress. Am J Cardiol. 2001;87:1346–50.PubMedCrossRef

84.

Taegtmeyer H. Tracing cardiac metabolism in vivo: one substrate at a time. J Nucl Med. 2010;51 Suppl 1:80S–7.PubMedCrossRef

85.

Bax JJ, Wijns W, Cornel JH, Visser FC, Boersma E, Fioretti PM. Accuracy of currently available techniques for prediction of functional recovery after revascularization in patients with left ventricular dysfunction due to chronic coronary artery disease: comparison of pooled data. J Am Coll Cardiol. 1997;30:1451–60.PubMedCrossRef

86.

Di Carli MF. Myocardial viability assessment with PET and PET/CT: in cardiac PET and PET/CT imaging. 1st ed. New York: Springer; 2007.

87.

Di Carli MF. The quest for myocardial viability: is there a role for nitrate-enhanced imaging? J Nucl Cardiol. 2003;10:696–9.PubMedCrossRef

88.

Di Carli MF, Davidson M, Little R, et al. Value of metabolic imaging with positron emission tomography for evaluating prognosis in patients with coronary artery disease and left ventricular dysfunction. Am J Cardiol. 1994;73:527–33.PubMedCrossRef

89.

Eitzman D, al-Aouar Z, Kanter HL, et al. Clinical outcome of patients with advanced coronary artery disease after viability studies with positron emission tomography. J Am Coll Cardiol. 1992;20:559–65.PubMedCrossRef

90.

Lee KS, Marwick TH, Cook SA, et al. Prognosis of patients with left ventricular dysfunction, with and without viable myocardium after myocardial infarction. Relative efficacy of medical therapy and revascularization. Circulation. 1994;90:2687–94.PubMedCrossRef

91.

Allman KC, Shaw LJ, Hachamovitch R, Udelson JE. Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis. J Am Coll Cardiol. 2002;39:1151–8.PubMedCrossRef

Titel: Nuclear Imaging in Ischemic Heart Disease
Auteurs: Sharmila Dorbala, MBBS, FACC
Marcelo F. Di Carli, MD, FACC
Uitgeverij: Springer US
Boek: Coronary Heart Disease
Print ISBN: 978-1-4614-1474-2

Elektronisch ISBN: 978-1-4614-1475-9

Copyright: 2012
DOI: https://doi.org/10.1007/978-1-4614-1475-9_4

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