IJCS | Volume 32, Nº1, January/ February 2019

79 Figure 6 - (A) 13 N perfusion PET and 18 FDG metabolism PET in short axis (SAO), horizontal long axis (HLA) and vertical long axis (VLA) showing extensive area of mismatch in the mid to distal anterior wall and apex (white arrow). (B) Polar map with quantitative analysis of the scar amount (7%) on the top (match defect) and hibernating myocardium (22%) on the bottom (mismatch). “Given the significant amount of hibernating myocardium, it was recommended that the patient proceed with coronary artery bypass grafting.” (adapted from Weifels et al., with permission). 73 (C) Cardiac MRI showing subendocardial scar involving > 75% of the myocardium from the basal to apical anteroseptal wall, mid to apical anterior wall and apex, suggesting no viability in the LAD territory in a patient with a history of previous anterior myocardial infarction and coronary angiogram showing occluded mid LAD. (D) Cardiac MRI of a patient with occluded proximal LAD with collaterals, 95% stenosis ostial LCx and occluded OM1 showing subendocardial scar from the basal to apical anterior wall, mid to apical anteroseptal wall, and basal to mid lateral wall involving < 50% myocardium, suggesting viability in the LAD and LCx territories. Given these findings, the patient went on to have CABG (LITA->LAD, left radial- >OM1, SVG->right PIV). He is clinically doing well one year post-CABG. LAD: left anterior descending artery; LCx: left circumflex artery; OM1: first marginal artery; SAO: short axis. Erthal et al. Myocardial viability: from PARR-2 to IMAGE HF - current evidence and future directions Int J Cardiovasc Sci. 2019;32(1)70-83 Review Article