Assessment of Myocardial Viability in Ischemic Cardiomyopathy

The number of patients with ischemic cardiomyopathy has increased extensively over recent years. Therapies include medical treatment, cardiac transplantation, cardiac resynchronization therapy and surgery. In the diagnostic and prognostic work-up, the assessment of myocardial viability has become more important over time. In particular, patients with viable myocardium can improve in LV function after revascularization; this will not occur in patients without viable tissue. In view of the high risk of surgery in this patient category, careful analysis is needed in order to justify the enhanced risk. Over the years, different viability techniques have been developed. In this review, these techniques are discussed. Moreover, the value of these techniques for the prediction of not only improvement of function, but also improvement in exercise capacity, reverse LV remodeling, and long-term prognosis, is discussed.