Myocardial Viability Assessment During Impella Support With 18-FDG PET Imaging

This is a small, technical report addressing a specific bedside problem: in a patient kept alive by an Impella heart pump after a major heart attack, can you safely scan the heart muscle to see how much of it is still viable?

The team performed 18-FDG PET imaging — the test that distinguishes living, recoverable muscle from dead scar — in patients supported by the device during cardiogenic shock. The scans were completed safely, with good image quality and no adverse events. The contribution is a proof of feasibility: a useful viability assessment can be done without removing or disrupting the mechanical support.

This is a case series, the most preliminary form of clinical evidence. It involves a handful of patients, no comparison group, and a feasibility endpoint rather than any patient outcome. Its audience is the intensivists and imaging specialists managing a narrow and critical situation.

We rate the evidence limited, as its design dictates. It is a sound first step for a specialized clinical question, not a finding that generalizes to cardiovascular prevention or to most patients’ decisions.