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(Circulation. 2004;109:1328-1334.)
© 2004 American Heart Association, Inc.

Review: Current Perspective

Role of Cardiac Magnetic Resonance Imaging in the Assessment of Myocardial Viability

Kesavan Shan, MD; Godwin Constantine, MD; Mohan Sivananthan, MD; Scott D. Flamm, MD

From the Department of Cardiology, Southwest Memorial Hospital, and The University of Texas Medical School, Houston, Tex (K.S.); The British Heart Foundation Cardiac MRI Unit, The General Infirmary at Leeds, Leeds, United Kingdom (G.C., M.S.); and Departments of Radiology and Cardiology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Department of Radiology, Baylor College of Medicine, Houston, Tex (S.D.F.).

Correspondence to Scott D. Flamm, MD, Department of Radiology, MC 2-270, St Luke’s Episcopal Hospital, 6720 Bertner Ave, Houston, TX 77030. E-mail sflamm@sleh.com

Key Words: magnetic resonance imaging • myocardial infarction • hibernation • myocardial stunning

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Dysfunctional myocardium that remains viable has the potential for contractile recovery after reperfusion.¹ Dysfunctional but viable myocardium has been broadly divided into 2 closely linked pathophysiological states, myocardial hibernation and stunning. Stunned myocardium is the result of an ischemic insult leading to contractile dysfunction despite adequate reperfusion. Hibernating myocardium describes downregulation of myocyte metabolism as a result of prolonged reduction in perfusion, or, in some cases, repetitive episodes of myocardial stunning.² The exact nature of structural changes in hibernating myocardium remains controversial.³ However, a spectrum of histological alterations has been noted, ranging from cellular dedifferentiation (fetal phenotype) to cellular degeneration (with more extensive fibrosis) with loss of contractile and cytoskeletal proteins. Worsening histological perturbations correlate with increasing duration of chronically low perfusion. Thus, accurate and early detection of viable myocardium has become an increasingly important guide to prognosis and therapy. Until recently, scintigraphic techniques and stress echocardiography were the mainstay of diagnosis.^4,5 The focus of the present article is on the rapidly emerging clinical role of cardiovascular MRI (CMR) in the detection of viable myocardium.

	Clinical Importance of Determining Myocardial Viability

 
In patients with chronic ischemic left ventricular dysfunction, improvements in ejection fraction and exercise capacity after revascularization have been well documented.^6–10 The prognostic importance of detecting myocardial viability hinges on 2 major considerations. First, medically treated viable myocardium is a harbinger of further nonfatal ischemic events and higher overall mortality. In patients with significant viable myocardium, the annual mortality rate is more than 4-fold greater in those treated medically compared with those patients who have . . . [Full Text of this Article]

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