Tunisia's Heartbeat : Pioneering Isotopic Techniques in Cardiac Viability Among Resource Challenges.

INTRODUCTION

In Tunisia, where healthcare resources are often limited, nuclear imaging techniques are revolutionizing cardiac care. They provide critical information on myocardial perfusion, contractile function, and metabolic processes, transforming the ischemic heart disease management.

AIM: This study explores the essential role of isotopic examinations in assessing myocardial viability and evaluates their impact on therapeutic decision-making.

METHODS

A prospective descriptive and analytical study was conducted on 40 patients for whom myocardial viability studies were indicated. All patients underwent isotopic examinations and coronary angiographies performed between January 2022 and June 2023.

RESULTS

Myocardial viability scintigraphy (MVS) showed that 62.5% of myocardial territories were non-viable, while 37.5% were hibernating. These results perfectly matched those obtained by 18FDG PET-CT. MVS proved to be a highly reliable tool that significantly influenced therapeutic decisions. Revascularization was indicated in 40% of patients with viable myocardium, while medical treatment was prescribed for all patients with non-viable myocardium. During a follow-up period, a significant improvement in left ventricular ejection fraction (LVEF) was observed in the group of patients with hibernating myocardium treated with revascularization compared to those treated medically (p=0.02). Additionally, non-viable group had a higher mortality rate (12%) compared to viable group (6.7%). Survival rates were better in the group with viable lesions (93% vs 85%).

CONCLUSIONS

This is the first prospective study conducted in Tunisia assessing the contribution of isotopic examinations in evaluating myocardial viability. The diagnostic value of MVS is comparable to metabolic imaging. Furthermore, nuclear imaging techniques can influence therapeutic management and provide information on long-term prognosis.