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Cardiac magnetic resonance for the assessment of myocardial viability: from pathophysiology to clinical practice

Dellegrottaglie, Santo; Guarini, Pasquale; Savarese, Gianluigi; Gambardella, Francesco; Iudice, Francesco Lo; Cirillo, Annapaola; Vitagliano, Alice; Formisano, Tiziana; Pellegrino, Angela M.; Bossone, Eduardo; Perrone-Filardi, Pasquale

Journal of Cardiovascular Medicine: December 2013 - Volume 14 - Issue 12 - p 862–869
doi: 10.2459/JCM.0b013e328362765e
Reviews: Imaging

Cardiac magnetic resonance (CMR) is commonly applied for the assessment of myocardial viability in patients with ischemic ventricular dysfunction, and it holds potential advantages over more traditional imaging modalities, including single-photon emission computed tomography (SPECT) and dobutamine stress echocardiography (DSE). CMR-based techniques for viability assessment include the evaluation of transmural extent of the scar using late gadolinium enhancement (LGE) images, the evaluation of end-diastolic wall thickness from resting cine images and the study of inotropic reserve during low-dose dobutamine infusion. During the past decade, the diffusion of the use of CMR for viability assessment confirmed the clinical strengths of this modality and, at the same time, helped to use old techniques with an increased level of awareness. With LGE CMR, both viable and nonviable dysfunctional myocardium can be visualized in a single image, allowing a direct quantification of the amount of regional viability, with a significant impact on the estimation of chance for recovery. As well, studies with CMR applied in the setting of ischemic heart disease allowed a better understanding of the best way to apply and interpret other tests for viability evaluation. For instance, it has been demonstrated that the transmural extension of the scar may influence the level of concordance between SPECT and DSE in assessing myocardial viability. The transmural extent of scar on LGE CMR also correlates with the timing of postrevascularization recovery of systolic function, with significant impact on the diagnostic accuracy of any applied imaging modality.

aDivision of Cardiology, Ospedale Medico-Chirurgico Accreditato Villa dei Fiori, Acerra, Naples, Italy

bZ. and M.A. Wiener Cardiovascular Institute and M.-J. and H.R. Kravis Center for Cardiovascular Health, Mount Sinai Medical Center, New York, NY, USA

cDepartment of Advanced Biomedical Sciences, Federico II University, Naples

dCardiology Division, ‘Cava de’ Tirreni and Amalfi Coast’ Hospital, Heart Department, University of Salerno, Italy

Correspondence to Pasquale Perrone-Filardi, MD, PhD, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy Tel: +39 081 746 2224; fax: +39 081 746 2224; e-mail:

Received 17 January, 2013

Revised 20 March, 2013

Accepted 21 April, 2013

© 2013 Italian Federation of Cardiology. All rights reserved.