Myocardial Viability In Patients Research Articles

1151-146 Assessment of myocardial viability in patients with myocardial infarction: Comparison of contrast-enhanced magnetic resonance imaging with dobutamine stress echocardiography

1151-146 Assessment of myocardial viability in patients with myocardial infarction: Comparison of contrast-enhanced magnetic resonance imaging with dobutamine stress echocardiography

Ischemic and viable myocardium in patients with Non–Q-Wave or Q-Wave myocardial infarction and left ventricular dysfunction: A clinical study using positron emission tomography, echocardiography, and electrocardiography

ObjectivesWe investigated whether patients with non–Q-wave myocardial infarction (NQMI) have more ischemic viable myocardium (IVM) than patients with Q-wave myocardial infarction (QMI). BackgroundNon–Q-wave myocardial infarction is associated with higher incidences of cardiac events than QMI, suggesting more myocardium at risk in NQMI. MethodsTo identify myocardial ischemia, hibernation, and scar, the resting and stress 82rubidium perfusion and F-18 fluorodeoxyglucose metabolic positron emission tomographic imaging (PET) was performed in 64 consecutive patients with NQMI (n = 21) or QMI (n = 43). Echocardiography was performed for assessment of left ventricular function and wall motion index (WMI). The relationships between PET, echocardiographic, and electrocardiographic findings were analyzed. ResultsThere were no significant differences in left ventricular ejection fraction (LVEF) between NQMI and QMI groups (28 ± 10% vs. 25 ± 11%, p > 0.05). Ischemic and viable myocardium was more common in NQMI than in QMI (91% vs. 61%, p < 0.05). The total amount of IVM was significantly higher in NQMI than in QMI (6.5 ± 5.2 vs. 2.9 ± 2.8 segments, p < 0.001). Neither the number of Q waves, residual ST-segment depression of ≥0.5 mm or elevation of ≥1 mm, nor LVEF and WMI were significant predictors for IVM. Wall motion index correlated with scar segments (r = 0.54, p < 0.001) and LVEF (r = −0.67, p < 0.001). ConclusionsIschemic and viable myocardium is common in patients with NQMI and left ventricular dysfunction, suggesting that aggressive approaches should be taken to salvage the myocardium at risk in such patients.

Comparison of TIMI Myocardial Perfusion Grade with Coronary Flow Reserve for Prediction of Recovery of LV Function and LV Remodeling in Acute Myocardial Infarction

Background and Objectives:The TIMI myocardial perfusion (TMP) grade is known as one of the methods to assess the viability of the myocardium in ischemic heart disease. This study was designed to assess the value of TMP grade itself and to evaluate the correlation with coronary flow reserve (CFR) in the prediction of left ventricular remodeling and functional change after percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI). Subjects and Methods:We measured CFR and TMP grade after successful elective PCI (diameter stenosis <30%, and TIMI flow 3) in 83 patients (mean age 55±1 years, 18 females) with AMI within 7 days of symptom onset. Left ventricular end diastolic volume index (LVEDVI), left ventricular end systolic volume index (LVESVI), ejection fraction (LVEF), and left ventricular regional wall motion score index (LVRWMSI) were assessed by echocardiography just before and at 9 months after angioplasty (mean 9±5 months). Results:Although they had achieved (TIMI 0.021) TIMI 3 flow after successful intervention, 27 of 83 patients (32.5%) had impaired myocardial perfusion. After PCI, angiographic TMP grade was well correlated with CFR measured using Doppler wire (TMP 0/1;1.4±0.3, TMP 2;1.9±0.6, TMP 3;2.2±0.4, rs=0.618, p=0.000). PostPCI TMP grade was significantly related to the change of LVEDVI (r=0.452, p=0.000), LVESVI (r=0.435, p= 0.000), LVEF (r=0.281, p=0.010) and LVRWMSI (r=0.328, p=0.036). Conclusion:The TMP grade, a simple angiographic method, might be useful as a predictor of LV volume and functional change in AMI. In the cardiac catheterization laboratory, it could simply replace CFR for the assessment of myocardial viability in patients who receive an elective PCI within 7 days of AMI onset. (Korean Circulation J 2004;34(3):247-257)

Myocardial Viability: Comparison of Free-Breathing Navigator-echo-gated Three-Dimensional Inversion-Recovery Gradient-Echo MR and Standard Multiple Breath-Hold Two-Dimensional Inversion-Recovery Gradient-Echo MR

Purpose: To compare a free-breathing, navigator-echo-gated, three-dimensional, inversion-recovery, gradientecho, MR pulse sequence (3D-MRI) with standard, multiple breath-hold, two-dimensional, inversion-recovery, gradient-echo MR (2D-MRI) for the evaluation of delayed hyperenhancement of nonviable myocardium in patients with chronic ischemic heart disease. Materials and Methods: Ten patients with chronic ischemic heart disease were enrolled in this study. MRI was performed on a 1.5-T system. 3D-MRI was obtained in the short axis plane at 10 minutes after the administration of Gd-DTPA (0.2 mmol/kg, 4 cc/sec). Prospective gating of the acquisition based on the navigator echo was applied. 2D-MRI was performed immediately after finishing 3D-MRI. The area of total and hyperenhanced myocardium measured on both image sets was compared with paired Student t-test and Bland-Altman method. By using a 60-segment model, the transmural extent and segmental width of the hyperenhanced area were recorded by 3-scale grading method. The agreement between the two sequences was evaluated with kappa statistics. We also evaluated the agreement of hyperenhancement among the three portions (apical, middle and basal portion) of the left ventricle with kappa statistics. Results: The two sequences showed good agreement for the measured area of total and hyperenhanced myocardium on paired t-test (p=0.11 and p=0.34, respectively). No systematic bias was shown on Bland-Altman analysis. Good agreement was found for the segmental width (ĸ=0.674) and transmural extent (ĸ=0.615) of hyperenhancement on the segmented analysis. However, the agreement of the transmural extent of hyperenhancement in the apical segments was relatively poor compared with that in the middle or basal portions. Conclusion: This study showed good agreement between 3D-MRI and 2D-MRI in evaluation of non-viable myocardium. Therefore, 3D-MRI may be useful in the assessment of myocardial viability in patients with dyspnea and children because it allows free-breathing during the examination.

QT dispersion and myocardial viability in patients after acute myocardial infarction

Background: In recent years QT dispersion (QTd) in post-infarct patients was estimated in many studies, but still little is known about its association with the presence of dysfunctional but viable myocardium. Aim: We investigated the relation between dispersion of QT interval and myocardial viability in patients after acute myocardial infarction (AMI). Material and methods: In 52 patients (mean age 67.2±11.7) treated thrombolitycally because of AMI 12-lead ECG and low dose–high dose dobutamine echocardiography was performed on 14th day after treatment. QTd and regional myocardial contractility were estimated three times: at baseline, low dose dobutamine (LDD) (10–15 μg/kg per min) and high dose dobutamine (HDD) infusion (up to 40 μg/kg per min). Results: Patients with viable myocardium had lower baseline QTd than patients with only necrosis in infarct zone. Significant increase in QTd was shown during LDD and HDD both in patients with and without myocardial viability. During infusion of HDD QTd was significantly higher in patients with myocardial ischemia. The greatest percentage increase of QTd at HDD was shown in patients with biphasic response to dobutamine infusion i.e. with myocardial viability evidenced at LDD and myocardial ischemia at HDD. Conclusion: Patients with preserved myocardial viability had lower QTd values compared to those with similar left ventricular dysfunction but caused only by post-infarction necrosis. Ischemia evoked on 14th day after AMI was accompanied by greater increase in QTd in patients with myocardial viability in infarct region than in patients without. It may be one of the reasons of greater risk of serious ventricular arrhythmias in such patients during myocardial ischemia.

115 Resolution of post-systolic strain as a non-invasive marker of successful revascularisation of viable myocardium in patients with ischaemic left ventricular dysfunction

115 Resolution of post-systolic strain as a non-invasive marker of successful revascularisation of viable myocardium in patients with ischaemic left ventricular dysfunction

738 Assessment of myocardial viability in patients with myocardial infarction: comparison of low dose dipyridamole radionuclide ventriculography with dipyridamole stress echocardiography

The purpose of the study was to compare diagnostic value of low dose dipyridamole radionuclide ventriculography (DIPY-RNV) and low dose dipiyidamole echocardiography (DIPY-ECHO) for the prediction of functional recovery of viable myocardium in the medium term follow up. Twenty patients (18 male; 51±10 years) with previous myocardial infarction and resting wall motion dyssynergy were studied before angioplasty of infarct related artery (IRA), by RNV and ECHO at rest, as well as during dipyridamole infusion (0,28 mcg/kg/min over 2min). RNV as well as ECHO was repeated at rest, 12 weeks after successful angioplasty. Five percent increase of regional ejection fraction (REF) by RNV was used as criterion for functional improvement of infarcted regions. By ECHO, viability was defined as improvement of wall thickening or contractile improvement of grade one or more, utilizing wall motion score index (WMSI). Out of 180 examined (20x9) segments by RNV, 51 were dyssynergic and they had abnormal REF (29±10%). Out of these 51 segments functional improvement was documented in 33 on low DIPY. Sensitivity for predicting functional recovery after 12 weeks follow up was 63%, and specificity was 77%. WMSI assessed by ECHO was 1.35±0.22, 1.16±0.20 and 1.13±0.14 for rest, low DIPY and rest follow up, respectively (p<0.05). Sensitivity of low DIPY-ECHO for predicting functional recovery was 80%, and the specificity was 90% (p=ns vs low DIPY-RNV). In conclusion, both techniques, RNV and ECHO are comparable diagnostic predictors of myocardial viability in medium term follow up.

674 Assessment of myocardial viability by acoustic densitometry in patients with left ventricle dysfunction due to coronary artery disease

Aim: The purpose of our study was to assess whether acoustic densitometry could distinguish between viable and irreversible dysfunctional myocardium in patients with coronary artery disease before myocardial revascularization. Methods: Seventy patients with chronic coronary artery disease and dysfunctional myocardial segments before planned myocardial revascularization were examined by acoustic densitometry. Fifty four patients had revascularization of at least one coronary artery supplying dysfunctional segments. Control echocardiography of these patients was performed after 3 months after bypass surgery or percutaneous coronary intervention for assessing contractility of revascularized, initially dysfunctional myocardial segments. The dysfunctional segments were defined as viable if they exhibited improvement in their thickening after revascularization. Wall motion was scored using 16-segment model of left ventricle, acoustic densitometry was evaluated from parasternal long axis view, parasternal short axis view at the level of papilary muscles and apical four-chamber and two-chamber views. Amplitude of cyclic variation of integrated backscatter (CVIB) was evaluated from each dysfunctional segment. Optimal cut off value of CVIB for distinction between viable and irreversible dysfunctional myocardium was found using receiver operating characteristic curves. Results: Cut off values for anteroseptal, posterior, interventricular septal, lateral, inferior and anterior segments were 4,1; 4,3; 4,4; 4,2; 4,5; 4,0 and 4,2 decibels, respectively. Sensitivity, specificity, positive and negative predictive values for identification of myocardial viability by acoustic densitometry using this cut off values were 918%, 81%, 87%, and 86%, respectively. Conclusion: Acoustic densitometry can differentiate viable and irreversible dysfunctional myocardium in patients with coronary artery disease before myocardial revascularization.

MR Imaging Evaluation of Myocardial Viability in the Setting of Equivocal SPECT Results with99mTc Sestamibi

To determine if contrast material-enhanced magnetic resonance (MR) imaging is useful for assessment of myocardial viability in patients with equivocal stress-rest results from single photon emission computed tomographic (SPECT) examination with technetium 99m sestamibi. Twenty patients underwent stress-rest SPECT examinations with sestamibi. Results were considered equivocal for assessment of myocardial infarct on the basis of fixed perfusion defects that either had normal wall motion or exceeded any wall motion abnormalities. Patients then underwent (a). contrast-enhanced MR imaging for assessment of myocardial infarct and (b). cine MR imaging for assessment of wall motion. For image analyses, the left ventricle was divided into 14 segments. Wall motion and extent of infarct were assessed independently and compared. Forty-one segments were equivocal for infarct at SPECT, and most (21 of 41 [51%]) involved the posterior or inferior wall. Infarct was confirmed with MR imaging in 10 of 41 (24%) equivocal segments in eight patients (40%). An additional 29 segments in eight patients had infarct at MR imaging that was not suspected at SPECT, including segments in three patients with no clinical history of myocardial infarct prior to imaging. All cases of infarct except one that were equivocal or undetected with sestamibi at SPECT were nontransmural at MR imaging, and most of the unsuspected subendocardial infarcts (15 of 28 [54%]) had no associated wall motion abnormalities. Patients with radionuclide examination findings that are equivocal for infarct may benefit from contrast-enhanced MR imaging, particularly in the setting of nontransmural infarct.

Tc-99m tetrofosmin tomography after nitrate administration in patients with ischemic left ventricular dysfunction: relation to metabolic imaging by PET

Background In patients with ischemic left ventricular (LV) dysfunction, myocardial perfusion imaging after nitrate administration may improve the identification of dysfunctional but viable myocardium. This study was designed to assess the relationship between tetrofosmin uptake after nitrate administration and metabolic activity as assessed by positron emission tomography (PET) in patients with ischemic LV dysfunction. Methods and results Thirty-six patients with chronic myocardial infarction and LV dysfunction (ejection fraction, 35% ± 6%) underwent resting technetium 99m tetrofosmin single photon emission computed tomography (SPECT) imaging under control conditions (baseline) and after sublingual administration of 10 mg isosorbide dinitrate. Within 1 week, all patients underwent metabolic PET imaging with fluorine 18–fluorodeoxyglucose. Tetrofosmin uptake and metabolic activity were measured in 13 segments/patient. Regional LV function was assessed in corresponding segments by echocardiography. On baseline tetrofosmin imaging, 53 (40%) of the 131 akinetic or dyskinetic segments had reduced (<55% of peak activity) tracer uptake. Of these segments, 14 (26%) showed enhanced tetrofosmin uptake after nitrate administration (≥10% vs baseline) and the remaining 38 (74%) did not change. The sensitivity and specificity of baseline tetrofosmin SPECT for detecting preserved metabolic activity were 69% and 86%, respectively. After nitrate administration, the sensitivity was higher (81%, P < .05 vs baseline) whereas the specificity was not different (86%, P = not significant). Concordance between tetrofosmin SPECT and PET in differentiating viable and necrotic myocardium was observed in 94 (72%) of the 131 akinetic or dyskinetic segments at baseline (κ = 0.35) and in 108 segments (82%) after nitrate administration (κ = 0.53). Conclusions After nitrate administration, tetrofosmin uptake in dysfunctional segments correlated with metabolic activity as assessed by fluorodeoxyglucose PET imaging better than baseline. Thus tetrofosmin SPECT after nitrate administration may improve the identification of ischemic but still viable myocardium in patients with chronic ischemic LV dysfunction.

ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: Summary Article: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to update the 1997 guidelines for the clinical application of echocardiography)

ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: Summary Article: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to update the 1997 guidelines for the clinical application of echocardiography)

Post-extrasystolic Potentiation Recruits Incremental Contractile Reserve of Dyssynergic Myocardium During Dobutamine Stress Testing: Evidence by Pulsed Wave Tissue Doppler Imaging

Dobutamine stress echocardiography is an established diagnostic method for the detection of myocardial viability in patients with severe left ventricular dysfunction [1] . The presence of viable myocardium identifies patients who will benefit from coronary revascularization, by improving both functional capacity and long-term survival. Occasionally, dobutamine infusion has been combined with other stressors, such as post-extrasystolic potentiation, in order to improve accuracy. The contractile reserve after combined dobutamine infusion and post-extrasystolic potentiation can be quantified by pulsed wave tissue Doppler imaging. We describe a patient with severe left ventricular dysfunction, in which pulsed wave tissue Doppler imaging allowed to demonstrate that post-extrasystolic potentiation superimposed on dobutamine infusion is able to further recruit contractile reserve, as compared to dobutamine infusion alone. A nuclear scan assessing glucose utilization was used as a reference. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.

Coronary collaterals: an important and underexposed aspect of coronary artery disease.

Important risk factors for cardiovascular disease (CVD) have been identified, but they fail to explain why some patients with atherosclerosis become symptomatic and have recurrent symptomatic disease, and others do not. Apart from the extent of coronary atherosclerosis (among other factors), the sensitivity of organs to episodes of ischemia is probably of importance. An organ may be less sensitive to episodes of ischemia if supplied with sufficient blood flow by well-developed collateral vessels. Unfortunately, some organs or even some individuals do not appear to have well-developed collateral vessels, if developed at all. At present, it is not clear why there are differences between individuals in their capability of developing a sufficient collateral circulation. The potential of individuals to develop coronary collateral circulation has so far been largely neglected but may play a major role in determining myocardial vulnerability. In the present article, we propose why coronary collaterals are important, and why this individual potential to develop collaterals should be considered an additional indicator of cardiac vulnerability. Also, we review determinants that play a role in collateral coronary blood supply. Coronary collaterals, or “natural bypasses,” are anastomotic connections without an intervening capillary bed between portions of the same coronary artery and between different coronary arteries (Figure 1).1 Collateral circulation potentially offers an important alternative source of blood supply when the original vessel fails to provide sufficient blood.2 Timely enlargement of collaterals may even avoid transmural myocardial infarction (MI) and death in symptomatic patients.3 As early as in 1956, Baroldi et al4 demonstrated the presence at birth of mostly corkscrew-shaped collaterals in normal human hearts, with a lumen diameter of 20 to 350 μm and lengths ranging from 1 or 2 cm to 4 or 5 cm. In hearts with typical findings of coronary disease at autopsy, …

Myocardial viability inchronic ischemic heart disease: Comparison of contrast-enhanced magnetic resonance imaging with 18F-fluorodeoxyglucose positron emission tomography

ObjectivesWe sought to compare contrast-enhanced magnetic resonance imaging (ceMRI) with nuclear metabolic imaging for the assessment of myocardial viability in patients with chronic ischemic heart disease and left ventricular (LV) dysfunction. BackgroundContrast-enhanced MRI has been shown to identify scar tissue in ischemically damaged myocardium. MethodsTwenty-six patients with chronic coronary artery disease and LV dysfunction (mean ejection fraction 31 ± 11%) underwent 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET), technetium-99m tetrofosmin single-photon emission computed tomography (SPECT), and ceMRI. In a 17-segment model, the segmental extent of hyperenhancement (SEH) by ceMRI, defined as the relative amount of contrast-enhanced tissue per myocardial segment, was compared with segmental FDG and tetrofosmin uptake by PET and SPECT. ResultsIn severely dysfunctional segments (n = 165), SEH was 9 ± 14%, 33 ± 25% (p < 0.05), and 80 ± 23% (p < 0.05) in segments with normal metabolism/perfusion, metabolism/perfusion mismatch, and matched defects, respectively. Segmental glucose uptake by PET was inversely correlated to SEH (r = −0.86, p < 0.001). By receiver operator characteristic curve analysis, the area under the curve was 0.95 for the differentiation between viable and non-viable segments. At a cutoff value of 37%, SEH optimally differentiated viable from non-viable segments defined by PET. Using this threshold, the sensitivity and specificity of ceMRI to detect non-viable myocardium as defined by PET were 96% and 84%, respectively. ConclusionsContrast-enhanced MRI allows assessment of myocardial viability with a high accuracy, compared with FDG-PET, in patients with chronic ischemic heart disease and LV dysfunction.

P3315 Value of myocardial blush grade to assess myocardial viability in patients with recent myocardial infarction

P3315 Value of myocardial blush grade to assess myocardial viability in patients with recent myocardial infarction

P2158 Estimation of myocardial perfusion relative to the presence of myocardial viability in patients with left-ventricular dysfunction during 3 months therapy with captopril or eprosartan

P2158 Estimation of myocardial perfusion relative to the presence of myocardial viability in patients with left-ventricular dysfunction during 3 months therapy with captopril or eprosartan

Electromechanical mapping versus positron emission tomography and single photon emission computed tomography for the detection of myocardial viability in patients with ischemic cardiomyopathy

ObjectivesWe compared catheter-based electromechanical mapping (NOGA system, Biosense-Webster, Haifa, Israel) with positron emission tomography (PET) and single photon emission computed tomography (SPECT) for prediction of reversibly dysfunctional myocardium (RDM) and irreversibly dysfunctional myocardium (IDM) in patients with severe left ventricular dysfunction. Furthermore, we established the optimal discriminatory value of NOGA measurements for distinction between RDM and IDM. BackgroundThe NOGA system can detect viable myocardium but has not been used for prediction of post-revascularization contractile function in patients with ischemic cardiomyopathy. MethodsTwenty patients (19 males, age [mean ± SD] 60 ± 16 years, ejection fraction [EF] 29 ± 6%) underwent viability testing with NOGA and PET or SPECT before revascularization. Left ventricular function was studied at baseline and six months after revascularization. ResultsThe EF increased to 34 ± 13% at six months (p < 0.05 vs. baseline). The 58 RDM and 57 IDM regions differed with regard to unipolar voltage amplitude (UVA) (9.2 ± 3.9 mV vs. 7.6 ± 4.0 mV, p < 0.05), normalized UVA (106 ± 54% vs. 75 ± 39%, p < 0.05), and tracer uptake (76 ± 17% vs. 60 ± 20%, p < 0.05). The NOGA local shortening did not distinguish between RDM and IDM (6.4 ± 5.8% vs. 5.4 ± 6.6%). By receiver operating characteristic curve analysis, myocardial tracer uptake had better diagnostic performance than UVA (area under curve [AUC] ± SE: 0.82 ± 0.04 vs. 0.63 ± 0.05, p < 0.05) and normalized UVA (AUC ± SE: 0.70 ± 0.05, p < 0.05). Optimal threshold was defined as the value yielding sensitivity = specificity for prediction of RDM. Sensitivity and specificity were 59% at a UVA of 8.4 mV, 65% at a normalized UVA of 83%, and 78% at a tracer uptake of 69%. ConclusionsThe NOGA system may discriminate RDM from IDM with optimal discriminatory values for UVA and normalized UVA of 8.4 mV and 83%, respectively. However, the diagnostic performance does not reach the level obtained by PET and SPECT in patients with severe heart failure.

Assessment of myocardial viability in patients with left ventricular dysfunction using contrast-enhanced magnetic resonance imaging: Comparison to 201-Thallium single photon emission computed tomography

Assessment of myocardial viability in patients with left ventricular dysfunction using contrast-enhanced magnetic resonance imaging: Comparison to 201-Thallium single photon emission computed tomography

Prognostic value of nitrate enhanced Tc99m MIBI SPECT study in detecting viable myocardium in patients with coronary artery disease.

Assessing the viability in akinetic myocardium is vital for predicting functional recovery after therapeutic management in patients with chronic coronary artery disease (CAD) and depressed left ventricular (LV) function. The present study aimed to evaluate the efficacy of Tc99m MIBI SPECT enhanced with nitroglycerine infusion in detecting myocardial viability, as well as to asses the relationship between the myocardial viability and the subsequent treatment and outcome of patients. Sixty-seven consecutive patients with CAD and LV dysfunction (LV ejection fraction 36.6 +/- 8.4%) underwent Tc99m MIBI imaging--at rest and during intravenous nitroglycerine infusion--for viability assessment. Fourteen patients were treated pharmacologically (Group I), and fifty-three (Group II) were submitted to coronary revascularization (PTCR or CABG). Fifteen major cardiac events were observed during 25 months of the follow-up. A significantly worse event-free survival was registered in the subjects of Group I than in Group II subjects. The prognostic predictors of cardiac events were: (1) the number of viable, non-revascularized segments in perfusion imaging (p < 0.001), (2) the severity of the disease assessed by coronary angiography (p < 0.05). Viability detection in nitroglycerine infusion enhanced Tc99m MIBI imaging offers significant prognostic value in patients with CAD after myocardial infarction. Patients with preserved viability showed better prognosis after revascularization than those treated pharmacologically.

Acute Myocardial Infarction: Myocardial Viability Assessment in Patients Early Thereafter—Comparison of Contrast-enhanced MR Imaging with Resting201Tl SPECT

To compare contrast material-enhanced magnetic resonance (MR) imaging with resting thallium 201 ((201)Tl) single photon emission computed tomography (SPECT) for predicting myocardial viability in patients early after acute myocardial infarction. Inversion-recovery contrast-enhanced MR images and resting (201)Tl SPECT images were obtained in 22 patients after acute myocardial infarction. The (201)Tl SPECT images were obtained 4.3 days +/- 0.2 (standard error) after the onset of myocardial infarction. Contrast-enhanced MR imaging was performed 7.9 days +/- 1.6 after (201)Tl SPECT. Transmural extent of hyperenhancement on contrast-enhanced MR images and regional (201)Tl activity were quantitatively analyzed with a 12-segment model. Regional wall thickening on follow-up cine MR images obtained 67 days +/- 17 after contrast-enhanced MR imaging was used as an index for myocardial viability. Statistical analyses were performed with the chi(2) and two-tailed Student t tests. Both contrast-enhanced MR and resting (201)Tl SPECT images showed significant correlations with regional wall thickening on follow-up cine MR images. The sensitivity, specificity, and accuracy of contrast-enhanced MR imaging in the prediction of viable myocardium were significantly higher than those of resting (201)Tl SPECT (98.0% vs 90.3%, P <.01; 75.0% vs 54.4%, P <.05; and 92.0% vs 81.1%, P <.001, respectively). Delayed contrast-enhanced MR imaging can help predict myocardial viability as seen on follow-up cine MR images after acute myocardial infarction, with significantly improved sensitivity, specificity, and accuracy in comparison with those of resting (201)Tl SPECT.