Assessment of myocardial viability in coronary artery disease

Modern therapeutic approaches in ischemic coronary artery disease such as thrombolysis, coronary angioplasty and secondary prevention have resulted in decreasing cardiac mortality. However, the infarct induced loss of contractile myocardium remains the main contributor to the development of left heart failure. Therefore, clinical interest has focused on the detection of dysfunctional but viable myocardium which may benefit from revascularization procedures. Today, a variety of imaging techniques allow to differentiate between irreversibly damaged scar tissue and viable myocardium. The decision for revascularization procedures in patients with compromised left ventricular function should be based on evidence of viable myocardium with partial or complete potential for functional recovery. In contrast, prognostic benefit of revascularization procedures in patients with predominantly scar tissue is questionable. Therefore these patients should receive medical treatment or heart transplantation in refractory left heart failure instead of being exposed to the risk of revascularization procedures.