Abstract
Chronic ischemic left ventricular dysfunction is present in number of clinical syndromes in which myocardial revascularization results in an improvement of left ventricular function, patients' functional class, and their survival. Coronary arteriography is of limited value in diagnosis of viability. Noninvasive testing, traditionally nuclear imaging, stress echocardiography and (stress) electrocardiography have been the clinical mainstays for assessing myocardial viability as well as to detect myocardial ischemia. However, cardiovascular magnetic resonance is a rapidly emerging noninvasive imaging technique, providing high-resolution images of the heart in any desired plane and without radiation. Rather than a single technique, cardiovascular magnetic resonance consists of several techniques that can be performed separately or in various combinations during a patient examination. Whereas, no single cardiovascular magnetic resonance technique has a perfect, or near perfect, sensitivity and specificity, therefore, a combination of various cardiovascular magnetic resonance techniques are needed for the assessment of myocardial viability. The aim of this review article is to summarize our current understanding of the concept of myocardial viability, to discuss the clinical value of cardiovascular magnetic resonance (in particular the different cardiovascular magnetic resonance techniques to assess viability) for the evaluation of patients with coronary artery disease and chronic left ventricular dysfunction and to present the current place of cardiovascular magnetic resonance among other techniques for the assessment of viable myocardium.
Highlights
The aim of this review article is to summarize our current understanding of the concept of myocardial viability, to discuss the clinical value of cardiovascular magnetic resonance for the evaluation of patients with coronary artery disease and chronic left ventricular dysfunction and to present the current place of cardiovascular magnetic resonance among other techniques for the assessment of viable myocardium
This study provided the first clinical evidence that DE-cardiovascular magnetic resonance (CMR) imaging was able to assess viability with recovery of function after revascularization as the study endpoint
Accurate viability assessment is possible with CMR using different techniques including EDWT measurement, dobutamine stress CMR (DSMR), and DECMR
Summary
Sigita Glaveckaitė , Nomeda Valevičienė , Aleksandras Laucevičius , Jelena Čelutkienė , Alfredas Rudys , Algirdas Tamošiūnas . The choice is frequently made between medical treatment and revascularization From this perspective, assessment of myocardial viability is important to guide management of patients with ischemic left ventricular dysfunction (LVD); patients with viable myocardium may improve in left ventricle (LV) function and/or survival after revascularization, whereas patients with only scar tissue will not improve. Definition and pathophysiology of hibernation In the early 1980s, Rahimtoola et al [9] reviewed the results of coronary bypass surgery trials and identified patients with CAD and chronic LVD that improved upon revascularization They proposed the concept of hibernating myocardium as “prolonged ischemia... The differentiation between repetitive stunning and hibernation may not be that important, since revascularization is required in both conditions in order to improve contractile function; from a practical viewpoint, both conditions can be grouped as “jeopardized myocardium” [11] or as single category of dysfunctional but viable myocardium.
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