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Updated: Aug 10, 2026

In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
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Myocardial Viability Assessment Before Surgical Revascularization in Ischemic Cardiomyopathy: JACC Review Topic of

Julio A Panza1, Lukasz Chrzanowski2, Robert O Bonow3

  • 1Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA; New York Medical College, Valhalla, New York, USA.

Journal of the American College of Cardiology
|September 3, 2021
PubMed

Insights

Myocardial viability testing in ischemic cardiomyopathy is evolving. Current approaches focus on protecting viable heart muscle from further damage, rather than solely on improving function post-revascularization.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Imaging

Background:

  • Ischemic cardiomyopathy involves scar tissue and dysfunctional but viable myocardium.
  • Myocardial viability assessment aims to select patients for revascularization.
  • Previous studies suggested improved outcomes with revascularization in patients with substantial viable myocardium.

Purpose of the Study:

  • To re-evaluate the role of viability testing in ischemic cardiomyopathy.
  • To explore contemporary applications of viability testing beyond predicting functional recovery.

Main Methods:

  • Review of observational studies and prospective trials on myocardial viability.
  • Analysis of recent findings on the mechanisms of revascularization benefits.

Main Results:

  • Prospective trials have not confirmed the interaction between myocardial viability and revascularization treatment effects.
  • Recovery of left ventricular function is not the primary mechanism for improved prognosis after revascularization.
  • A contemporary application of viability testing focuses on preventing further myocardial damage.

Conclusions:

  • The primary goal of surgical revascularization may be to protect residual viable myocardium from acute coronary events.
  • Viability testing may be repurposed to identify patients who benefit from protection of viable myocardium.

Keywords:
coronary artery diseaseheart failureischemic cardiomyopathyleft ventricular functionmyocardial viability

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