Relationship between extent of jeopardized myocardium derived from myocardial viability study to post-myocardial infarction outcome

OBJECTIVE: This study aimed to assess the relationship between the extent of jeopardized myocardium, quantified using cardiac viability imaging, and clinical outcomes in patients after myocardial infarction. By utilizing rest myocardial perfusion imaging (MPI) and cardiac 18F-fluorodeoxyglucose PET/computed tomography (18F-FDG PET/CT) analyzed with Emory Cardiac Toolbox software (ECTb), the study aimed to determine how quantitative viability parameters correlate with left ventricular functional recovery and post-myocardial infarction outcomes, and to assess their utility in guiding clinical decision-making. METHODS: This prospective study included 85 patients who underwent 2-day rest MPI followed by cardiac FDG-PET/CT imaging. Quantitative parameters, including the percentage of jeopardized myocardium, comprising viable, scarred, and total jeopardized myocardial segments, along with left ventricular ejection fraction (LVEF) were obtained using the ECTb platform (version 4.2). The relationship between these quantitative PET parameters and functional myocardial recovery, defined as improvement in ≥5% LVEF as assessed by two-dimensional echocardiography, was evaluated using receiver operating characteristic curve analysis. Follow-up was conducted over a period of 3 months, 6 months, and 1 year to assess the association between baseline quantitative imaging parameters and the occurrence of adverse cardiac events. RESULTS: The analysis demonstrated that the extent of viable myocardium was a strong predictor of functional recovery (area under the curve, 0.762; P < 0.001), with a cutoff of approximately 17% yielding 76.7% sensitivity, 68.8% specificity, and 71.8% accuracy. Major adverse cardiac events (MACE) occurred in 16% of patients. There was no significant association with imaging parameters, except a nonsignificant trend for scar burden in medically managed patients. Patients undergoing surgical intervention had a significantly greater extent of jeopardized myocardium, underscoring the role of viability imaging in therapeutic decision-making. CONCLUSION: The extent of viable myocardium identified through imaging was strongly correlated with functional recovery, as reflected by improvements in cardiac function on follow-up echocardiography. Although no significant relationship with MACE was seen in the overall cohort, the higher burden of jeopardized myocardium in surgically treated patients underscores the value of viability imaging in guiding revascularization decisions, supporting FDG-PET/CT as a useful tool for post-myocardial infarction risk stratification and management.