Pharmacologic intervention in cardiovascular nuclear medicine procedures.

Overview

Relevant questions in ischemic heart disease are (1) what is the ischemic threat? (2) What is the extent of ventricular dysfunction? (3) Is the observed dysfunction reversible? Exercise testing can help to identify the ischemic threat. Catheterization studies have shown that resting ventricular dysfunction can be reversed in some patients through pharmacologic or surgical intervention. However, improved ventricular performance in ischemic heart disease may be achieved through a variety of mechanisms. Insight into all components of cardiac performance (regional and global contractillity, preload, afterload, and heart rate) and myocardial perfusion may be required to adequately describe the influence of intervention. Exercise radionuclide ventriculographic studies have demonstrated that stress-induced ventricular dysfunction can be reversed through surgical and pharmacologic intervention. Studies at rest have demonstrated that radionuclide techniques can detect drug-induced changes in ventricular performance in groups of patients. The challenge to cardiovascular nuclear medicine is the prospective identification of patients who would benefit most from aggressive intervention aimed at preventing or reversing ischemic ventricular dysfunction.