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Published on: February 16, 2016
Assessment of Myocardial Viability in Ischemic Cardiomyopathy With Reduced Left Ventricular Function Undergoing
Arian Arjomandi Rad1,2, Eleni Tserioti2, Dimitrios E Magouliotis3
1Division of Medical Sciences, University of Oxford, Oxford, UK.
Insights
Assessing myocardial viability before coronary artery bypass grafting (CABG) improves patient outcomes. Imaging techniques like SPECT and DSE help identify viable myocardium, reducing the risk of death after CABG.
Area of Science:
- Cardiology
- Medical Imaging
- Cardiac Surgery
Background:
- Myocardial viability assessment is crucial for patients undergoing coronary artery bypass grafting (CABG).
- Current knowledge on clinical markers for viability across imaging modalities needs comprehensive review.
- Comparing mortality in viable versus nonviable myocardium post-CABG is essential.
Purpose of the Study:
- To review myocardial viability assessment in CABG patients.
- To focus on clinical markers for each imaging modality.
- To compare mortality between patients with viable and nonviable myocardium undergoing CABG.
Main Methods:
- Systematic database search and meta-analysis of comparative original articles (observations and RCTs).
- Included studies from EMBASE, MEDLINE, Cochrane, and Google Scholar up to 2022.
- Modalities evaluated: dobutamine stress echocardiography (DSE), cardiac magnetic resonance (CMR), SPECT, and PET.
Main Results:
- 17 studies with 2317 patients were included.
- Reduced relative risk of death post-CABG in patients with viable myocardium (OR: 0.42; 95% CI: 0.29-0.61).
- SPECT or DSE are recommended first-line; PET or CMR for further evaluation.
Conclusions:
- Myocardial viability assessment is essential for preoperative evaluation in ischemic heart disease patients.
- Accurate assessment guides treatment decisions and predicts outcomes.
- Individualized patient selection and viability assessment are paramount for surgical revascularization.
Background:
We aim to provide a comprehensive review of the current state of knowledge of myocardial viability assessment in patients undergoing coronary artery bypass grafting (CABG), with a focus on the clinical markers of viability for each imaging modality. We also compare mortality between patients with viable myocardium and those without viability who undergo CABG.
Methods:
A systematic database search with meta-analysis was conducted of comparative original articles (both observations and randomized controlled studies) of patients undergoing CABG with either viable or nonviable myocardium, in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to 2022. Imaging modalities included were dobutamine stress echocardiography (DSE), cardiac magnetic resonance (CMR), single-photon emission computed tomography (SPECT), and positron emission tomography (PET).
Results:
A total of 17 studies incorporating a total of 2317 patients were included. Across all imaging modalities, the relative risk of death post-CABG was reduced in patients with versus without viability (random-effects model: odds ratio: 0.42; 95% confidence interval: 0.29-0.61; p < 0.001). Imaging for myocardial viability has significant clinical implications as it can affect the accuracy of the diagnosis, guide treatment decisions, and predict patient outcomes. Generally, based on local availability and expertise, either SPECT or DSE should be considered as the first step in evaluating viability, while PET or CMR would provide further evaluation of transmurality, perfusion metabolism, and extent of scar tissue.
Conclusion:
The assessment of myocardial viability is an essential component of preoperative evaluation in patients with ischemic heart disease undergoing surgical revascularization. Careful patient selection and individualized assessment of viability remain paramount.
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