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Updated: May 16, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Assessing the available techniques for testing myocardial viability: what does the future hold?
Brian P Shapiro1, Patricia J Mergo, Christopher O Austin
1Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA. shapiro.brian@mayo.edu
Insights
Assessing myocardial viability is crucial for patients with severe coronary artery disease and left ventricular dysfunction. Viability testing may guide treatment decisions, though its impact on long-term survival remains under investigation.
Area of Science:
- Cardiology
- Medical Imaging
- Cardiovascular Disease
Background:
- Severe coronary artery disease (CAD) with left ventricular dysfunction presents a complex clinical challenge.
- Patients with CAD and reduced ejection fraction have poor prognoses, but outcomes vary after revascularization.
- Irreversibly scarred myocardium may not benefit from revascularization, unlike viable but hibernating myocardium.
Purpose of the Study:
- To review the role and current evidence regarding myocardial viability testing in patients with ischemic cardiomyopathy.
- To discuss the potential benefits and limitations of viability assessment in guiding therapeutic strategies.
- To highlight emerging technologies in the field of viability testing.
Main Methods:
- Review of existing literature on myocardial viability testing in ischemic cardiomyopathy.
- Discussion of various noninvasive imaging modalities for assessing myocardial viability.
- Consideration of the predictive value of viability testing for functional recovery and prognosis.
Main Results:
- Myocardial viability testing can predict regional and global functional recovery of the left ventricle.
- The ability of current viability studies to predict long-term survival and overall prognosis is not yet definitively proven in prospective studies.
- Some patients with hibernating myocardium may benefit from revascularization, while those with transmural infarction are less likely to recover function.
Conclusions:
- Myocardial viability testing is a valuable tool for selecting patients who may benefit from revascularization, despite inconclusive data on survival benefits.
- Noninvasive viability assessment aids in tailoring treatment strategies for patients with ischemic cardiomyopathy.
- Advancements in imaging technologies like PET and cardiac MRI are expected to further refine viability assessment in the future.
Abstract:
Left ventricular dysfunction in the setting of severe coronary artery disease poses a major diagnostic and therapeutic dilemma. While this clinical scenario is generally associated with poor outcomes, some but not all patients benefit from coronary revascularization. For example, patients with severe, transmural myocardial infarctions may derive little or no functional benefit from revascularization, as the underlying myocardium is irreversibly scarred. Furthermore, these patients may be exposed to high procedural risks with a low likelihood of deriving any perceivable benefit. Conversely, hibernating myocardium reflects a substrate whereby the nonfunctioning myocytes are chronically ischemic but may be viable. Existing data are somewhat inconclusive with regard to the benefits of performing viability testing in patients with ischemic cardiomyopathy. While this testing may predict regional and global functional myocardial recovery, the ability of viability studies to predict survival and prognosis remains unproven in prospective studies to date. Yet, viability testing may still be a valuable tool to guide therapeutic options in selected patients. A variety of noninvasive viability tests are available and newer technologies, such as PET and cardiac MRI, are likely to advance the scientific field in years to come.
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