Assessment of myocardial viability with MR—the Cologne perspective

4. Conclusion

Despite the evaluation of different parameters of myocardial viability by PET, TEE and MRI, their positive and negative predictive accuracies are fairly comparable. Therefore, the choice of the method to date mainly depends on expertise and available resources. An accepted reference standard to assess the diagnostic accuracy of imaging techniques is the post-revascularization recovery of regional LV function. In this respect, dobutamine-MRI proved to be a reliable and clinically feasible approach in a head to head comparison with FDG-PET and dobutamine-TEE. However, there is still limited information with respect to the potential benefit of revascularization procedures in the clinically important subset of patients with viable myocardium, markedly reduced LV function and congestive heart failure. In this patient population, the advantageous features of MRI including high spatial and temporal resolution, three-dimensional capability with unlimited field of view and the capability to measure perfusion may increase the clinical impact of MRI compared to established imaging techniques. Moreover, improvement of global LV ejection fraction, alleviation of symptoms and survival are fundamental clinical end points to additionally evaluate the predictive value of MR-studies for clinical decision making in patients with left ventricular dysfunction and persisting viable myocardial tissue.