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Updated: May 13, 2026

In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
08:13

In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography

Published on: February 16, 2016

Is ischemia the most powerful indicator of myocardial viability?

Jamshid Shirani1

  • 1Department of Cardiology, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA, 18015, USA. jamshid.shirani@sluhn.org

Current Cardiology Reports
|March 21, 2013
PubMed

Insights

Recent trials question coronary revascularization for stable ischemic heart failure. Determining myocardial viability may not reliably identify patients benefiting from this intervention.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine
  • Heart Failure Research

Background:

  • Chronic symptomatic ischemic heart failure is a significant cause of illness and death.
  • The role of coronary revascularization in managing stable ischemic heart failure is debated.
  • Identifying myocardial viability (viable vs. scarred tissue) has been proposed to guide revascularization decisions.

Purpose of the Study:

  • To review current evidence on ischemia-guided strategies for evaluating and treating chronic ischemic heart disease.
  • To assess the utility of myocardial viability determination in patient selection for revascularization.

Main Methods:

  • Review of prospective, randomized, multi-center clinical trials.
  • Analysis of evidence regarding ischemia-guided approaches.
  • Examination of challenges in clinical trial conduct for ischemic heart disease.

Main Results:

  • Several randomized trials have raised questions about the benefits of early coronary revascularization in stable ischemic heart failure.
  • The predictive value of assessing myocardial viability for selecting patients who benefit most from revascularization is challenged.
  • Practical difficulties in conducting ideal clinical investigations for ischemic heart disease have been highlighted.

Conclusions:

  • Evidence for an ischemia-guided approach in chronic ischemic heart disease with left ventricular systolic dysfunction needs careful consideration.
  • Personalized and goal-directed management strategies are crucial for ischemic heart disease.
  • Further research is needed to optimize treatment paradigms for ischemic heart failure.

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