Clinical impact of multimodality assessment of myocardial viability.
Lisa CantonNicole SumaSara AmiconeAndrea ImpellizzeriFrancesca BodegaVirginia MarinelliMariachiara CiarlantiniMarcello CasusoLeonardo BavusoRebecca BelàJessica SalernoMatteo ArmillottaFrancesco AngeliAngelo SansonettiDomenico AttinàVincenzo RussoLuigi LovatoDomenico TuttolomondoNicola GaibazziLuca BergamaschiCarmine PizziPublished in: Echocardiography (Mount Kisco, N.Y.) (2024)
Coronary artery disease (CAD) is a prevalent cause of left ventricular dysfunction. Nevertheless, effective elective revascularization, particularly surgical revascularization, can enhance long-term outcomes and, in selected cases, global left ventricular contractility. The assessment of myocardial viability and scars is still relevant in guiding treatment decisions and selecting patients who are likely to benefit most from blood flow restoration. Although the most recent randomized studies challenge the notion of "hibernating myocardium" and the clinical usefulness of assessing myocardial viability, the advancement of imaging techniques still renders this assessment valuable in specific situations. According to the guidelines of the European Society of Cardiology, non-invasive stress imaging may be employed to define myocardial ischemia and viability in patients with CAD and heart failure before revascularization. Currently, several non-invasive imaging techniques are available to evaluate the presence and extent of viable myocardium. The selection of the most suitable technique should be based on the patient, clinical context, and resource availability. This narrative review evaluates the characteristics of available imaging modalities for assessing myocardial viability to determine the most appropriate therapeutic strategy.
Keyphrases
- left ventricular
- coronary artery disease
- heart failure
- high resolution
- blood flow
- percutaneous coronary intervention
- cardiac resynchronization therapy
- hypertrophic cardiomyopathy
- coronary artery bypass grafting
- acute myocardial infarction
- left atrial
- end stage renal disease
- open label
- chronic kidney disease
- type diabetes
- acute coronary syndrome
- cardiovascular disease
- peritoneal dialysis
- study protocol
- mass spectrometry
- phase iii