Myocardial viability-State of the art: Is it still relevant and how to best assess it with imaging?

Area of Science:

• Cardiology
• Medical Imaging
• Cardiovascular Disease

Background:

• Ischemic cardiomyopathy (ICM) is a major cause of death, with coronary artery disease (CAD) leading to left ventricular (LV) systolic dysfunction.
• Coronary revascularization can improve LV function and outcomes in patients with viable myocardium.

Purpose of the Study:

• To review the literature on viability imaging for predicting functional recovery after revascularization in ICM.
• To describe the role and methods of viability imaging in clinical practice.
• To discuss controversies and future directions in viability imaging.

Main Methods:

• Review of extant literature on myocardial viability imaging.
• Description of commonly used modalities: dobutamine stress echocardiography (DSE), nuclear imaging, and cardiac MRI (CMR).
• Analysis of patient-centered perspectives and controversies.

Main Results:

• Viability imaging is essential for identifying patients likely to benefit from revascularization.
• DSE, nuclear imaging, and CMR are key modalities for assessing myocardial viability.
• Current utility of viability imaging is debated, necessitating further research.

Conclusions:

• Viability imaging plays a critical role in managing patients with ICM and CAD.
• Accurate assessment of myocardial viability guides treatment decisions and improves patient outcomes.
• Future research should address current controversies and refine imaging techniques.