How to prepare patients for fluorine-18 fluorodeoxyglucose positron emission tomography myocardial viability assessment.

Myocardial viability assessment can be valuable in the management of selected patients with moderate-to-severe ischemic cardiomyopathy. Among the viability imaging modalities, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) is a key tool for evaluating myocardial metabolic activity, helping to distinguish viable myocardium from scar tissue. Optimal metabolic preparation is crucial to enhance myocardial glucose uptake and ensure accurate imaging, particularly in diabetic patients with variable insulin resistance. This review presents a clinical case illustrating the role of 18F-FDG PET in myocardial viability assessment, explores different metabolic preparation protocols, and examines their clinical implications. The hyperinsulinemic euglycemic clamp (HEC) remains the most effective technique; however,alternative protocols, such as intravenous glucose loading with insulin, are increasingly utilized for their efficiency and practicality. A comparative analysis of these methods provides insight into their suitability for different patient populations. This review also emphasizes the importance of a standardized yet adaptable approach to metabolic preparation,considering individual patient factors and institutional resources. Emerging literature supporting optimized PET imaging protocols is highlighted to help guide clinical decision-making for revascularization in patients with moderate-to-severe ischemic cardiomyopathy.