By Vasken Dilsizian MD, Jagat Narula MD, DM, PhD (auth.)
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Additional resources for Atlas of Nuclear Cardiology
Increased myocardial blood flow is associated with improvement in regional left ventricular ejection fraction (LVEF) in these abnormally perfused regions of myocardium, while myocardial regions with normal baseline perfusion show no change in regional LYEE The reduction in blood flow in nonischemic regions by ~-blockade most probably reflects the reduction in myocardial oxygen demands induced by the reduction in myocardial contractility and work. On the other hand, the decrease in myocardial oxygen demand of the ischemic area by ~-blockade may restore vascular autoregulation and allow the ischemic vasculature to regulate its blood flow.
Thus, an asynergic but viable region may have reduced (but not absent) blood flow at rest (hibernation) or transient reduction in blood flow after a period of ischemia (stunning). Although standard stress-3- to 4-hour redistribution 20lTl scintigraphy may underestimate the presence of ischemic but viable myocardium in . Blood lOI TI 2 Post-stress myocardial uptake redistribution Time, h , " 3-h 1 , " t I II • ,, , ,, ' , , '. 1 Blood (2U1 TI I Post- Ires myocardial uptake A (irrever ible d f o II :~ .....
Thus, two separate sets of slices mapping the 99mTc-sestamibi and FDG distribution were simultaneously obtained, resulting in one-to-one correspondence in spatial registration. Rest 99mTc-sestamibi images in the horizontal long-axis plane (top row) show reduced perfusion in the apical and lateral regions (arrow). Corresponding FDG images (bottom row) show preserved metabolism in the apical and lateral regions suggestive of viable myocardium (arrow). (From Delbeke et al. ) -----------------------------_:.
Atlas of Nuclear Cardiology by Vasken Dilsizian MD, Jagat Narula MD, DM, PhD (auth.)