Assessing myocardial viability in patients with ischemic left ventricular dysfunction

Left ventricular (LV) function is one of the most powerful predictors of prognosis in the setting of heart failure (HF) or following myocardial infarction. It is important to differentiate patients in whom LV dysfunction is caused by necrosis and scar tissue formation from those with LV dysfunction because of ischemia or hibernating, but viable myocardium. Previous studies showed that identification of the latter group of patients predicts substantial survival benefit, symptomatic improvement, and improved LV function with revascularization. On the other hand, more recent investigations, such as the Surgical Treatment for Ischemic Heart Failure (STICH) trial [3], did not find a significant interaction between myocardial-viability status and medical versus surgical treatment with respect to the rates of death from any cause or from cardiovascular causes or the rate of death or hospitalization for cardiovascular causes.