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Assessment of myocardial viability by nuclear imaging in coronary heart disease

Prem Soman, MD, PhD, FACC, FRCP (UK)
James E Udelson, MD, FACC
Section Editor
Jeroen J Bax, MD, PhD
Deputy Editor
Brian C Downey, MD, FACC


Coronary heart disease (CHD) is the major cause of heart failure [1]. (See "Epidemiology and causes of heart failure".)

In the past, severe left ventricular (LV) dysfunction was considered an irreversible condition, as regional akinesis was thought to represent infarcted myocardial tissue. It is now understood that, among patients with ischemic cardiomyopathy, LV systolic dysfunction can result from myocardial necrosis and remodeling, myocardial hibernation, or repetitive myocardial stunning. While myocardial necrosis is irreversible, systolic dysfunction resulting from hibernation and stunning are potentially reversible states of ventricular dysfunction. (See "Pathophysiology of stunned or hibernating myocardium".)

Most patients with chronic heart failure have an admixture of all three pathophysiologic entities [2]. Clinical studies have shown that viable myocardium can be demonstrated in a substantial number of patients with CHD and LV dysfunction, even in the absence of angina [2-5]. (See "Evaluation of hibernating myocardium" and "Ischemic cardiomyopathy: Treatment and prognosis".)

In patients with significant amounts of viable myocardium, LV function may improve markedly, and even normalize, following successful revascularization (figure 1) [6-8]. An estimated 20 to 40 percent of patients with chronic ischemic LV dysfunction have the potential for significant improvement in LV function after revascularization [9]. (See "Ischemic cardiomyopathy: Treatment and prognosis".)

The outcome following revascularization is dependent not only on the presence but also the extent of viability, and a critical threshold mass of viable myocardium may be necessary for functional recovery and prognostic benefit to occur from revascularization [10-13]. Therefore, while several clinical and laboratory parameters including anginal symptoms, absence of Q waves on the electrocardiogram, and regional hypokinesis (as opposed to akinesis) on echocardiography indicate the presence of some viability, a systematic assessment of the degree and extent of viability is generally thought to be helpful for management planning and prognostication.

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Literature review current through: Sep 2017. | This topic last updated: Jan 13, 2016.
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