Assessing the available techniques for testing myocardial viability: what does the future hold?

• Published in: Future cardiology Vol. 8; no. 6; pp. 819 - 836
• Main Authors: Shapiro, Brian P, Mergo, Patricia J, Austin, Christopher O, Kantor, Birgit, Gerber, Thomas C
• Format: Journal Article
• Language: English
• Published: England Future Medicine Ltd 01.11.2012
• Subjects: Cardiology - methods; Care and treatment; Coronary artery bypass; coronary artery disease; Diagnosis; dobutamine echocardiogram; Forecasting; Health aspects; Heart - physiology; Heart attack; Humans; ischemic cardiomyopathy; left ventricle; Magnetic Resonance Imaging; Methods; myocardial infarction; positron emission tomography; single-photon emission computed tomography; Tissue Survival; viability; United States
• ISSN: 1479-6678; 1744-8298
• DOI: 10.2217/fca.12.59

Left ventricular dysfunction in the setting of severe coronary artery disease poses a major diagnostic and therapeutic dilemma. While this clinical scenario is generally associated with poor outcomes, some but not all patients benefit from coronary revascularization. For example, patients with severe, transmural myocardial infarctions may derive little or no functional benefit from revascularization, as the underlying myocardium is irreversibly scarred. Furthermore, these patients may be exposed to high procedural risks with a low likelihood of deriving any perceivable benefit. Conversely, hibernating myocardium reflects a substrate whereby the nonfunctioning myocytes are chronically ischemic but may be viable. Existing data are somewhat inconclusive with regard to the benefits of performing viability testing in patients with ischemic cardiomyopathy. While this testing may predict regional and global functional myocardial recovery, the ability of viability studies to predict survival and prognosis remains unproven in prospective studies to date. Yet, viability testing may still be a valuable tool to guide therapeutic options in selected patients. A variety of noninvasive viability tests are available and newer technologies, such as PET and cardiac MRI, are likely to advance the scientific field in years to come.