Myocardial Viability Testing in the Management of Ischemic Heart Failure

Abstract

Although major advances have occurred lately in medical therapy, ischemic heart failure remains an important cause of death and disability. Viable myocardium represents a cause of reversible ischemic left ventricular dysfunction. Coronary revascularization may improve left ventricular function and prognosis in patients with viable myocardium. Although patients with impaired left ventricular function and multi-vessel coronary artery disease benefit the most from revascularization, they are at high risk of complications related to revascularization procedure. An important element in selecting the patients for myocardial revascularization is the presence of the viable myocardium. Multiple imaging modalities can assess myocardial viability and predict functional improvement after revascularization, with dobutamine stress echocardiography, nuclear imaging tests and magnetic resonance imaging being the most frequently used. However, the role of myocardial viability testing in the management of patients with ischemic heart failure is still controversial due to the failure of randomized controlled trials of revascularization to reveal clear benefits of viability testing. This review summarizes the current knowledge regarding the concept of viable myocardium, depicts the role and tools for viability testing, discusses the research involving this topic and the controversies related to the utility of myocardial viability testing and provides a patient-centered approach for clinical practice.

Development of a Novel Nomogram to Predict Major Adverse Cardiac Events in Patients with Chronic Total Occlusion

“…The pivotal pathophysiological transformations within CTO encompass myocardial stunning and hibernation 21 . Prolonged reduction in resting blood flow leads to chronic ventricular wall motion abnormalities, initiating myocardial hibernation and subsequently contributing to HF and ischemic cardiomyopathy 22 . While myocardial metabolism imaging is the gold standard for identifying viable myocardium 10 , the controversy surrounding its use in treating patients with CTO persists.…”

Determination of viable myocardium through delayed enhancement cardiac magnetic resonance imaging combined with 18F-FDG PET myocardial perfusion/metabolic imaging before CABG

“…Secondly, the short follow up time, and especially no moderate- or long- term follow up data was available on MACE events. Moreover, there are ongoing debates regarding the use of myocardial viability in managing patients with ischemic heart failure [ 28 ]. To achieve a better understanding and to provide more reliable results it is necessary to conduct research with larger sample sizes, long follow up periods, randomized and control clinical trials.…”

Exploring Unusual Cardiac Complications: Chorda Tendinea Rupture and Pulmonary Valve Vegetation in Infective Endocarditis—A Comprehensive Review

“…Positron emission tomography (PET), specifically 18F-fluorodeoxyglucose PET combined with computed tomography (18F-FDG PET/CT), has demonstrated notable efficacy in diagnosing prosthetic valve endocarditis and cardiac device-related infections, boasting high sensitivity (87%) and specificity (94%) [49,50]. This imaging modality highlights areas of heightened glucose metabolism corresponding to active inflammation, offering valuable insights into disease activity [49].…”