Top Things to Know: State of the Art: Imaging for Myocardial Viability
Published: July 13, 2020
Prepared by Johanna A. Sharp, MSN, RN, Science and Medicine Advisor
- There are new therapies for myocardial infarction, but up to one-third of patients with acute myocardial infarction will still develop heart failure.
- Ischemic heart disease affects more than 110 million individuals worldwide.
- Controversy exists about the use of non-invasive imaging techniques for detecting myocardial viability and those patients appropriate for revascularization. This statement discusses current knowledge, interprets clinical trial results, and evaluates knowledge gaps.
- Imaging for myocardial viability is an essential tool for proper utilization of invasive treatment strategies and patient prognostication.a
- Assessing resting left ventricle size and function is fundamental to the evaluation of myocardial viability. Dobutamine stress echocardiography is a readily available imaging tool for assessing contractile reserve.
- Nuclear scintigraph methods provide an assessment of regional myocardial perfusion and metabolism, having the greatest sensitivity for identifying myocardial functional recovery following revascularization.
- Contrast-enhanced cardiac magnetic resonance imaging provides an accurate assessment of the trans-mural extent of the myocardial scar with high spatial resolution and contrast-to-noise ratio in characterizing myocardial tissue.
- Noninvasive imaging findings identify patients at higher risk for experiencing sudden cardiac death.
- Clinical scenarios are used to highlight viability assessments; algorithms proposed in this statement will facilitate clinical decision making.
- Despite the lack of clinical trial evidence to support that viability testing leads to improved survival, it still plays an important role in clinical decision making for patients with ischemic heart disease.
Citation
Garcia MJ, Kwong RY, Scherrer-Crosbie M, Taub CC, Blankstein R, Lima J, Bonow RO, Eshtehardi P, Bois JP; on behalf of the American Heart Association Council on Cardiovascular Radiology and Intervention and Council on Clinical Cardiology. State of the art: imaging for myocardial viability: a scientific statement from the American Heart Association. Circ Cardiovasc Imaging. 2020;13:e000053. doi: 10.1161/HCI.0000000000000053.