Congestive heart failure myocardial viability study

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Myocardial Viability Studies

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Medical Therapy:

Summary
Acute Pharmacotherapy
Chronic Pharmacotherapy in HFpEF
Chronic Pharmacotherapy in HFrEF
Diuretics
ACE Inhibitors
Angiotensin receptor blockers
Aldosterone Antagonists
Beta Blockers
Ca Channel Blockers
Nitrates
Hydralazine
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Exercise Training

Surgical Therapy:

Biventricular Pacing or Cardiac Resynchronization Therapy (CRT)
Implantation of Intracardiac Defibrillator
Ultrafiltration
Cardiac Surgery
Left Ventricular Assist Devices (LVADs)
Cardiac Transplantation

ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
Patients with current or prior symptoms of heart failure (Stage C)
Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
Quality Metrics/Performance Measures

Implementation of Practice Guidelines

Congestive heart failure end-of-life considerations

Specific Groups:

Special Populations
Patients who have concomitant disorders
Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Sara Zand, M.D.[2] Lakshmi Gopalakrishnan, M.B.B.S. [3]

Overview

Single-photon emission CT (SPECT) can also be used to assess myocardial ischemia and viability, myocardial inflammation or infiltration. Scintigraphy with technetium (Tc)-labeled bisphosphonate has shown high sensitivity and specificity for imaging cardiac transthyretin amyloid.

Myocardial Viability Studies

Common imaging modalities to assess myocardial viability include:

2021 European Society of Cardiology Guidelines (DO NOT EDIT) [1]

Class IIb
"Non-invasive stress imaging (CMR, stress echocardiography, SPECT, PET) may be considered for the assessment of myocardial ischemia and viability in patients with CAD who are considered suitable for coronary revascularization. (Level of Evidence: B) "
". Exercise testing may be considered to detect reversible myocardial ischemia and investigate the cause of dyspnea(Level of Evidence: C) "

2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) [2]

Class IIa
"6. In patients with HF, an evaluation for possible ischemic heart disease can be useful to identify the cause and guide management. [3][4][5][6] (Level of Evidence:B-NR) "

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References

  1. ↑ McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland J, Coats A, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam C, Lyon AR, McMurray J, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano G, Ruschitzka F, Kathrine Skibelund A (September 2021). "2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure". Eur Heart J. 42 (36): 3599–3726. doi:10.1093/eurheartj/ehab368. PMID 34447992 Check |pmid= value (help). Vancouver style error: initials (help)
  2. ↑ Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM; et al. (2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (18): e876–e894. doi:10.1161/CIR.0000000000001062. PMID 35363500 Check |pmid= value (help).
  3. ↑ Elhendy A, Sozzi F, van Domburg RT, Bax JJ, Schinkel AF, Roelandt JR; et al. (2005). "Effect of myocardial ischemia during dobutamine stress echocardiography on cardiac mortality in patients with heart failure secondary to ischemic cardiomyopathy". Am J Cardiol. 96 (4): 469–73. doi:10.1016/j.amjcard.2005.04.004. PMID 16098295.
  4. ↑ Miller WL, Hodge DO, Tointon SK, Rodeheffer RJ, Nelson SM, Gibbons RJ (2004). "Relationship of myocardial perfusion imaging findings to outcome of patients with heart failure and suspected ischemic heart disease". Am Heart J. 147 (4): 714–20. doi:10.1016/j.ahj.2003.10.045. PMID 15077089.
  5. ↑ Chow BJW, Coyle D, Hossain A, Laine M, Hanninen H, Ukkonen H; et al. (2021). "Computed tomography coronary angiography for patients with heart failure (CTA-HF): a randomized controlled trial (IMAGE-HF 1C)". Eur Heart J Cardiovasc Imaging. 22 (9): 1083–1090. doi:10.1093/ehjci/jeaa109. PMID 32588042 Check |pmid= value (help).
  6. ↑ Ferreira JP, Rossignol P, Demissei B, Sharma A, Girerd N, Anker SD; et al. (2018). "Coronary angiography in worsening heart failure: determinants, findings and prognostic implications". Heart. 104 (7): 606–613. doi:10.1136/heartjnl-2017-311750. PMID 28798192.
  7. ↑ Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW (May 2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (18): e895–e1032. doi:10.1161/CIR.0000000000001063. PMID 35363499 Check |pmid= value (help).

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