Ischemia and Viability Testing in New-Onset Heart Failure

Area of Science:

• Cardiology
• Cardiovascular Imaging
• Heart Failure Research

Background:

• Heart failure with reduced ejection fraction (HFrEF) of unclear etiology necessitates comprehensive coronary artery disease (CAD) assessment.
• Identifying ischemic cardiomyopathy is vital as revascularization improves outcomes in HFrEF patients.

Purpose of the Study:

• To review the utility and methods for assessing CAD in new-onset HFrEF patients with unknown causes.
• To evaluate the role and techniques of myocardial viability assessment for guiding revascularization in ischemic cardiomyopathy.

Main Methods:

• Review of current literature on non-invasive and invasive diagnostic tools for CAD.
• Analysis of imaging modalities including radionuclide myocardial perfusion imaging, coronary CT angiography (CCTA), and cardiac magnetic resonance (CMR).
• Examination of viability testing techniques and their application in clinical decision-making.

Main Results:

• Non-invasive imaging (radionuclide perfusion, CCTA, CMR) is effective for CAD assessment in HFrEF, serving as an alternative to invasive coronary angiography (ICA).
• Surgical revascularization in ischemic cardiomyopathy-induced HFrEF is associated with reduced long-term mortality and hospitalizations.
• Various non-invasive modalities effectively detect viable myocardium, though optimal use for guiding revascularization requires individualized approaches.

Conclusions:

• Stepwise algorithms for CAD and viability assessment are proposed for patients with new-onset HFrEF.
• Non-invasive imaging provides valuable alternatives to ICA for diagnosing CAD in HFrEF of unclear etiology.
• Individualized application of viability imaging is recommended to guide coronary revascularization decisions.