A 62-year-old man with severe three-vessel coronary disease and left ventricular dysfunction undergoes rest perfusion imaging and FDG PET. The lateral wall shows markedly reduced perfusion but normal FDG uptake. This perfusion-metabolism pattern indicates:

• A Non-viable scar, unlikely to benefit from revascularisation
• B Hibernating myocardium, likely to improve after revascularisation ✓
• C Stunned myocardium from a recent infarct
• D Normal myocardium, since FDG uptake is preserved

Explanation

Reduced resting perfusion with preserved or increased FDG uptake is a perfusion-metabolism mismatch, the signature of hibernating myocardium: chronically underperfused but viable myocytes that downregulate contractile function. These segments recover function after successful revascularisation. Matched reduction of both perfusion and metabolism indicates transmural scar with poor recovery potential. Stunning refers to transient post-ischaemic dysfunction with normal resting flow, and preserved FDG uptake alone does not mean the segment is normally perfused.

Reference: Braunwald's Heart Disease, 12th ed.

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Written and medically reviewed by the StethoPrep medical team.