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Updated: Aug 9, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
MRI assessment of myocardial viability
Andre Schmidt1, Katherine C Wu
1Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA.
Insights
Assessing left ventricular (LV) function is crucial in coronary artery disease. Cardiac magnetic resonance imaging (CMR) offers advanced noninvasive techniques for evaluating myocardial viability, guiding treatment decisions for heart failure.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Global left ventricular (LV) systolic function is a critical prognostic indicator in coronary artery disease (CAD).
- Survivors of myocardial infarction often have residual myocardial damage, increasing future risk for developing congestive heart failure (CHF).
- Differentiating between scarred, infarcted myocardium and viable, dysfunctional myocardium is essential for effective clinical management.
Purpose of the Study:
- To review noninvasive imaging techniques for assessing myocardial viability in patients with CAD.
- To highlight the advantages of cardiac magnetic resonance imaging (CMR) in evaluating LV function and myocardial viability.
- To discuss the implications of identifying viable myocardium for revascularization strategies.
Main Methods:
- Overview of noninvasive imaging modalities used for viability assessment.
- Focus on cardiac magnetic resonance imaging (CMR) techniques.
- Discussion of CMR's capabilities including high spatial resolution, 3D imaging, and soft tissue differentiation.
Main Results:
- Noninvasive imaging assesses myocardial viability by demonstrating contractile reserve, perfusion, intact myocyte membranes, or preserved metabolism.
- CMR allows simultaneous assessment of regional wall motion, perfusion, and metabolism.
- CMR is an increasingly accepted clinical tool for viability assessment due to its comprehensive capabilities.
Conclusions:
- Identifying viable myocardium in patients with LV dysfunction is crucial for improving outcomes through revascularization.
- CMR provides a versatile and powerful tool for comprehensive assessment of myocardial viability.
- Advanced imaging techniques like CMR are paramount in managing patients with CAD and preventing CHF progression.
Abstract:
In the presence of coronary artery disease, global left ventricular (LV) systolic function is a critical prognostic indicator. Because of enhanced therapy for myocardial infarction, more patients survive but are left with residual myocardial damage that predisposes them to developing CHF in the future. Although treatments for CHF are evolving, preventing and minimizing further deteriorations in LV function are paramount in this population. Distinguishing severe LV dysfunction caused by thinned, infarcted myocardium with fibrosis and scarring from that due to viable but dysfunctional myocardium from chronic hypoperfusion has significant implications for clinical management. In patients in whom noninvasive testing identifies viability, undergoing revascularization improves outcomes. Noninvasive imaging techniques used to assess viable myocardium are based on demonstrating the presence of one or more of the following features: (1) contractile reserve; (2) sufficient perfusion for the delivery of substrates and removal of metabolic byproducts; (3) intact myocyte membranes to maintain ionic/electrochemical gradients; and (4) preserved metabolism with generation of high-energy phosphates. While nuclear and dobutamine echocardiography have been widely used for viability assessment, cardiac magnetic resonance imaging (CMR) is increasingly becoming an accepted clinical tool, particularly in light of its high spatial resolution, intrinsic ability to image 3-dimensionally, and greater soft tissue differentiation. Moreover, the versatility of the technique potentially allows for the simultaneous assessment of regional wall motion, perfusion, and metabolism. An overview of the CMR techniques is presented.
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