Myocardial Viability: Heart Failure Perspective


This review highlights the different imaging modalities available to assess myocardial viability in patients with heart failure and coronary artery disease (CAD) being considered for revascularization.


Myocardial viability can be determined by a variety of cardiac imaging modalities. Recent studies have confirmed the use of cardiovascular magnetic resonance imaging (CMR) in patients with heart failure and CAD, suggesting that those who undergo revascularization but have evidence of residual viable or ‘jeopardized’ myocardium have increased mortality compared with those who achieve complete revascularization. The PET and Recovery Following Revascularization (PARR)-2 trial assessed whether viability noted on PET imaging in patients with severe LV dysfunction correlated with recovery of LV function and response to revascularization. The 5-year extension of the PARR-2 study noted a significant decrease in the composite outcome of cardiac death, myocardial infarction, or cardiac hospitalization in patient assessments adherent to PET-guided viability recommendations.


On the basis of the current available data, viability testing is reasonable in individuals with ICM, as identified by coronary angiography in whom complete revascularization can be achieved. Whenever available, the use of CMR or PET is preferred because of better resolution and increased sensitivity to detect myocardial viability.