Myocardial Viability: Wanted (Not So) Dead or Alive (CE)

This course will present the concept of myocardial viability and define the terms stunned and hibernating myocardium. Several studies demonstrating the importance of determining the presence of viable myocardium will be presented. Evaluating for the presence of viable myocardium using dobutamine ECHO, myocardial SPECT, F-18 FDG PET and contrast enhanced MRI will be discussed to include advantages and disadvantages of each. Future directions in the detection of viable myocardium as well as possible concepts in management to avoid myocardial necrosis with early detection of injury.

Upon completion of the presentation and with a minimum of 80% proficiency, each attendee will be able to:

1. Explain the concept of myocardial viability and the terms stunned and hibernating myocardium;
2. Understand the landmark trials that reported the impact of determining myocardial viability and the outcomes with appropriate treatment;
3. Recognize the various modalities that might be used to determine myocardial viability including SPECT, dobutamine ECHO, MRI and PET;
4. Be aware of future directions for detection of viable myocardium

OUTLINE
Myocardial Viability: Wanted (Not so) Dead or Alive

1. Definitions
   a) Stunned myocardium
   b) Stunned myocardium
   c) Hibernating myocardium
2. F-18 FDG PET
   a) Basic cardiac metabolism
   b) Understanding the imaging process
   c) Apoptosis
3. Landmark studies
   a) CASS study
   b) STITCH trial
4. Techniques
   a) Dobutamine stress echo
   b) Nuclear SPECT
   c) F-18 FDG PET
   d) MRI
   e) PET vs. MRI
5. Advance/future techniques
   a) PET-MR
   b) Apoptosis imaging
   c) Matrix netalloproteinase