The Current Role of Viability Imaging to Guide Revascularization and Therapy Decisions in Patients With Heart Failure and Reduced Left Ventricular Function

The Canadian Journal of Cardiology
Riina M KandolinLisa M Mielniczuk

Abstract

This review describes the current evidence and controversies for viability imaging to direct revascularization decisions and the impact on patient outcomes. Balancing procedural risks and possible benefit from revascularization is a key question in patients with heart failure of ischemic origin (IHF). Different stages of ischemia induce adaptive changes in myocardial metabolism and function. Viable but dysfunctional myocardium has the potential to recover after restoring blood flow. Modern imaging techniques demonstrate different aspects of viable myocardium; perfusion (single-photon emission computed tomography [SPECT], positron emission tomography [PET], cardiovascular magnetic resonance [CMR]), cell metabolism (PET), cell membrane integrity and mitochondrial function (201Tl and 99mTc-based SPECT), contractile reserve (stress echocardiography, CMR) and scar (CMR). Observational studies suggest that patients with IHF and significant viable myocardium may benefit from revascularization compared with medical treatment alone but that in patients without significant viability, revascularization appears to offer no survival benefit or could even worsen the outcome. This was not supported by 2 randomized trials (Surgical Treatment f...Continue Reading

Citations

Sep 6, 2019·Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology·Rob S B Beanlands
Sep 4, 2020·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Hyungdon KookCheol Woong Yu
Jan 3, 2021·Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology·Juliana Brenande de Oliveira BritoTerrence D Ruddy
Jan 17, 2021·The Canadian Journal of Cardiology·Robert J H MillerNowell M Fine
Jun 17, 2020·Seminars in Nuclear Medicine·Gedaliah FarberBenjamin H Rotstein
Aug 1, 2021·Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology·Xiaoliang ShaoYuetao Wang

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