Clinical nuclear cardiology: flow tracers and free fatty acid analogs to detect viable myocardium after infarction.

Among the available invasive and noninvasive modalities, nuclear cardiology techniques utilizing single photon emission computerized tomography (SPECT) have achieved a preeminent position for the assessment of myocardial viability. This arises from the rather unique potential of scintigraphic methods to assess myocardial perfusion, cell membrane integrity, and metabolic activity. The purpose of this article is to review the relative merits and limitations of myocardial flow tracers (thallium and sestamibi) and metabolic tracers (fatty acid analogs) to identify residual myocardial viability in patients with coronary artery disease and left ventricular dysfunction.