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Updated: Jun 22, 2025
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Clinical impact of multimodality assessment of myocardial viability
Lisa Canton1,2, Nicole Suma1,2, Sara Amicone1,2
1Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy.
Insights
Coronary artery disease (CAD) impacts left ventricular function. Assessing myocardial viability with advanced imaging helps guide revascularization strategies, improving outcomes in select heart failure patients.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Coronary artery disease (CAD) frequently leads to left ventricular dysfunction.
- Effective revascularization, especially surgical, can improve long-term outcomes and contractility in specific cases.
Purpose of the Study:
- To review available non-invasive imaging modalities for assessing myocardial viability.
- To guide the selection of the most appropriate imaging technique for patients with CAD and heart failure.
Main Methods:
- Narrative review of current non-invasive imaging techniques for myocardial viability assessment.
- Evaluation of imaging characteristics in the context of European Society of Cardiology guidelines.
Main Results:
- Myocardial viability assessment remains relevant for guiding revascularization in selected CAD patients, despite recent study challenges.
- Advancements in imaging techniques offer valuable tools for evaluating viable myocardium.
Conclusions:
- Non-invasive stress imaging is recommended by ESC guidelines for assessing ischemia and viability before revascularization in CAD patients with heart failure.
- The choice of imaging modality should be individualized based on patient factors, clinical context, and available resources.
Abstract:
Coronary artery disease (CAD) is a prevalent cause of left ventricular dysfunction. Nevertheless, effective elective revascularization, particularly surgical revascularization, can enhance long-term outcomes and, in selected cases, global left ventricular contractility. The assessment of myocardial viability and scars is still relevant in guiding treatment decisions and selecting patients who are likely to benefit most from blood flow restoration. Although the most recent randomized studies challenge the notion of "hibernating myocardium" and the clinical usefulness of assessing myocardial viability, the advancement of imaging techniques still renders this assessment valuable in specific situations. According to the guidelines of the European Society of Cardiology, non-invasive stress imaging may be employed to define myocardial ischemia and viability in patients with CAD and heart failure before revascularization. Currently, several non-invasive imaging techniques are available to evaluate the presence and extent of viable myocardium. The selection of the most suitable technique should be based on the patient, clinical context, and resource availability. This narrative review evaluates the characteristics of available imaging modalities for assessing myocardial viability to determine the most appropriate therapeutic strategy.
