Viability testing to guide myocardial revascularisation in patients with heart failure

Abstract

Myocardial revascularisation has the potential to restore ventricular function and improve survival in patients with heart failure due to underlying coronary artery disease. Viability testing is routinely used to identify which patients are likely to benefit, given that revascularisation may entail substantial procedural risk. However, while the concept of viability testing and revascularisation of patients with 'hibernating myocardium' is strongly supported by observational series, randomised studies have failed to demonstrate clear benefit. This divergence in the evidence base is reflected in current European and US guidelines, in which viability testing has a class II recommendation. In this article, we review the current evidence for routine viability testing prior to revascularisation of patients with heart failure, outline its use in clinical practice and discuss ongoing trials in the field.

Myocardial Viability Testing in the Management of Ischemic Heart Failure

“…Hibernating myocardium is viable, so in different investigation methods, a conserved cell membrane integrity and metabolic activity, the absence of scar and the presence of contractile reserve can be identified [6]. Available imaging tools that assess myocardial viability can evaluate the structural and functional integrity of cardiomyocyte and the intracellular processes in the myocardial cells [31].…”

“…Improving of symptoms, LV ejection fraction and increased overall survival were reported after the revascularization of dysfunctional but viable myocardium in observational studies. However, the peri-operative risk is significant, and revascularization may be quite challenging in this type of patients with poor ejection fraction [4][5][6][7][8]. Commonly these patients are old, frail and with multiple Life 2022, 12, 1760 2 of 29 comorbidities [9].…”

A feasibility study of [18F]F-AraG positron emission tomography (PET) for cardiac imaging – myocardial viability in ischemia-reperfusion injury model

“…Delineation of a clear boundary between viable myocardium and brotic scar in the post-MI patients is clinically challenging [6,7]. A number of imaging methods have been utilized that enable the localization and semi-quanti cation of the viability of myocardium [8][9][10][11]. The commonly used modalities for assessing myocardial viability are cardiac magnetic resonance (CMR), dobutamine stress echocardiography (ECG), single photon emission computed tomography (SPECT) with 99m Tc-Sestamibi, and positron emission tomography (PET) with 2-deoxy-2[ 18 F] uoro-D-glucose ([ 18 F]FDG) [12].…”