Litteraturstudie av hjertets viabilitet

Abstract

Abstract:

Purpose: Ischemic heart disease is one of the leading causes of morbidity and death in Norway and many industrialized countries. In the treatment of this disease, information on size of scar tissue and amount of viable myocardium is essential. The purpose of the present literature study was to review the role of the currently used methods for assessment of myocardial viability, including echocardiography, magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT), and positron emission tomography (PET).

Methods: Using the database Pubmed, several searches were performed combining myocardial viability and the various methods.

Results, discussion and conclusion: Dobutamine stress echocardiography (DSE) has long been used to assess myocardial viability; DSE is highly specific yet less sensitive than other diagnostic tests for identification of dysfunctional but viable myocardium. Addition of newer echocardiographic methods such as myocardial contrast echocardiography, tissue Doppler and strain has potential to improve the role of echocardiography. Cardiac MRI has several techniques for assessment of viability: dobutamin stress, strain, and late enhancement. The overall accuracy of MRI appears to be equivalent, and in several reports, superior to the other available techniques. SPECT is well established and widely available,and has higher sensitivity but poorer specificity compared with DSE. PET has better spatial resolution than SPECT, but limited availability and cost as major disadvantages. PET has for many years been considered the «gold standard» for assessment of myocardial viability, but that role is challenged by MRI, which may be the new gold standard in assessment of myocardial viability.