From Imaging to Intervention: Insights from Nuclear Imagingin Revascularization Strategies for Coronary Artery Disease

Abstract

Background: Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide and is often associated with ischemic left ventricular dysfunction. In these patients, myocardial viability assessment is important when considering revascularization. Hybrid nuclear imaging modalities, including rest single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI) and 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), provide complementary information on myocardial perfusion, function, ischemia, and metabolism, enabling identification of viable and nonviable myocardium and supporting treatment selection.

Materials and Methods: This retrospective observational study included 75 post-myocardial infarction patients with angiographically confirmed CAD who underwent rest SPECT MPI and 18F-FDG PET for myocardial viability assessment at INMAS, Dhaka, between December 2020 and November 2024. Perfusion-metabolism patterns were analyzed in relation to coronary anatomy, ventricular function, and subsequent treatment decisions.

Results: Combined MPI-PET imaging differentiated viable myocardium from nonviable scar and identified mismatch, matched defect, and reverse mismatch patterns across different coronary territories. A perfusion-metabolism mismatch pattern suggestive of hibernating myocardium was observed in 18% of patients. Based on integrated clinical and imaging findings, 34 patients (45.3%) underwent revascularization, including 23 CABG and 11 PCI, whereas 41 patients (54.7%) received optimal medical therapy. In the revascularized group, mean left ventricular ejection fraction improved from 34.7 ± 7.6% at baseline to 43.2 ± 6.65% on follow-up echocardiography performed 3–6 months after intervention.

Conclusion: Rest SPECT MPI combined with 18F-FDG PET is a valuable tool for myocardial viability assessment in patients with CAD and ischemic cardiomyopathy. This integrated imaging approach facilitates more accurate identification of patients likely to benefit from revascularization and supports individualized treatment planning. Its incorporation into routine clinical practice may strengthen therapeutic decision-making and ultimately improve cardiovascular outcomes.

J Inv Clin Cardiol 2024; 6(2): 49-56