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We describe a case of implantable cardioverter-defibrillator (ICD) lead infection that was diagnosed by means of sulesomab imaging whereas ultrasound examinations were inconclusive. Nuclear techniques may be helpful in such, not infrequent, settings.

From over ten years, the assessment of myocardial viability in akinetic zones (stunned or hibernating myocardium) is considered fundamental to the correct management of postinfarction patients. The assessment can be performed with myocardial scintigraphy (201Thallium rest-redistribution, dobutamine stress echocardiography, MRI, 18F-fluorodeoxyglucose PET). A number of experiences have shown that scintigraphy is very sensitive but poorly specific in the assessment of myocardial akinetic zones with contractile functional recovery after revascularization. However, most recent reports have highlighted that the recovery of contractile function is not the single purpose of myocardial revascularization; in fact, it is able to prevent or attenuate remodeling, the contractile reserve is maintained or enhanced, the diastolic function is improved, arrhythmias are prevented, symptoms and functional capacity are improved. Therefore, the role of very sensitive procedures as myocardial scintigraphy or MRI of the heart is still of major diagnostic and prognostic significance. The present socioeconomic situation and the most recent advances in cardiology tend to shift the clinician's interest from the diagnosis to the prognosis of patients with ischemic heart disease and consequently, from maximum diagnostic accuracy to the highest prognostic value and maximum cost/effective benefit. Therefore, the nuclear cardiologist must become familiar with this novel terminology and new diagnostic and prognostic end-points.