The role of myocardial viability in contemporary cardiac practice

Abstract

Ischemic heart disease (IHD) remains the single most common cause of death worldwide. Ischemic cardiomyopathy is a major sequel of coronary artery disease. The economic health burden of IHD is substantial. In patients with old myocardial infarction (OMI), the extent of viable myocardium (VM) directly affects the short- and long-term outcome. There is a considerable collection of observational data showing substantial improvement in patients with significant left ventricular dysfunction when the need for revascularization is guided by preoperative assessment of viability and hibernation. However, a major challenge for present cardiovascular imaging is to identify better ways to assess viable but inadequately perfused myocardium and thus optimize selection of patients for coronary revascularization. Several non-invasive techniques have been developed to detect signs of viability. Hence, our aim is to provide the reader a state-of-the art review for the assessment of myocardial viability.

Personalized Cardiac Computational Models: From Clinical Data to Simulation of Infarct-Related Ventricular Tachycardia

“…An essential element of our model was the anatomical and functional modeling of the infarcted region. We based our patient-specific anatomical MI model on cardiac DE-MRI (see Figure 2), which is the current gold-standard technique for in-vivo assessment of myocardial ischemic injury in clinical environments (Jamiel et al, 2017; Patel et al, 2017). Moreover, DE-MRI is a routine imaging technique recommended for infarcted patients referred for RFA procedures (Pedersen et al, 2014; Priori et al, 2015), so it satisfies our requisite of exclusively using non-invasive clinical data.…”

“…At present, cardiac delayed enhancement-MRI (DE-MRI) is commonly used to explore the infarcted area pre-operatively, since it enables in-vivo evaluation of the tissue damaged by MI (i.e., scar and BZ) due to the hyper-enhancement of the infarcted region in the images (Kim et al, 1999a; Fieno et al, 2000; Doltra et al, 2013). In fact, it is currently considered as the gold-standard test for in-vivo assessment of scar and myocardial viability after MI in clinical settings (Jamiel et al, 2017; Patel et al, 2017). Cardiac DE-MRI provides a substrate characterization after MI that has shown close correlation with histopathological analyzes (Kim et al, 1999a; Fieno et al, 2000; Wagner et al, 2003; Amado et al, 2004), allowing to differentiate between scar and BZ.…”

Atualização da Diretriz Brasileira de Cardiologia Nuclear – 2020

“…As condições fisiopatológicas e mecanismos agudos e crônicos de adaptação à redução temporária do fluxo coronário incluem o atordoamento, hibernação e précondicionamento, de modo isolado ou coexistindo no mesmo paciente. 261 Por conseguinte, a avaliação da viabilidade miocárdica é importante no processo de decisão terapêutica dos pacientes com disfunção ventricular (grau de recomendação ou classe I -nível de evidência B) naqueles sem angina, [262][263][264][265][266] pois a melhora funcional não ocorrerá na presença de fibrose. Várias técnicas de imagem não invasivas são disponíveis para a detecção do miocárdio viável, entre elas a ecocardiografia de estresse com dobutamina, a ressonância cardíaca e as imagens nucleares com SPECT ou PET.…”

“…Essas avaliam diferentes características do miocárdio viável e por isso, apresentam variações na sensibilidade e especificidade. 261 Na CPM técnica SPECT o emprego do tálio-201 ( 201 Tl) é método estabelecido para a avaliação da perfusão miocárdica e integridade da membrana celular, sendo que quando comparado aos outros radiofármacos e técnicas disponíveis, torna-se de escolha para determinação de viabilidade. 267,268 Adicionalmente e ao lado destas técnicas não invasivas que objetivam informações funcionais e/ou anatômicas e que compõem a base para a abordagem da fisiopatologia da IC subjacente, apropria-se também a TC de múltiplos detectores.…”

Introduction to the Special Issue: Myocardial Imaging in Heart Failure

“…However, viability remains a routinely ordered test in patients with ischemic cardiomyopathy who are being considered for revascularization. Jamiel and colleagues [11] reviewed the current controversy around viability imaging in the current era and identified knowledge gaps in the viability literature. They provide recommendations that could help when applying the test results in everyday clinical care of patients.…”