Effect of Myocardial Viability Assessed by Cardiac Magnetic Resonance on Survival in Patients With Severe Left Ventricular Dysfunction

Abstract

6 These findings were corroborated in the smaller Heart Failure Revascularisation Trial (HEART), in which the presence of viable myocar-dium did not confer survival benefit in percutaneously or surgically revascularized subjects with ischemic HF compared with conservative management. 7 Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) accurately depicts the transmural extent of myocardial infarct 8,9 and correlates well with myocardial perfusion-metabolism mismatch, 10 the conventional gold standard for myocardial viability. A <50% extent of transmural LGE is predictive of left ventricular segmental contractile recovery after revascularization. 9,11 Of note, the use of LGE for myocardial viability assessment was not widespread at the inception of the STICH and HEART studies, and there is sparse literature on its effect on clinical outcomes after coronary revascularization or D espite major treatment advances, ischemic heart failure (HF) remains a significant cause of morbidity and mortality worldwide. Coronary artery revas-cularization may improve left ventricular contractility and function, as well as clinical outcomes in patients with viable myocardium, 1 but the usefulness of myocardial viability assessment in decision making regarding revascularization in ischemic HF remains controversial. In the Surgical Treatment for IsChemic Heart failure (STICH) trial, there were fewer incident deaths from cardiovascular (CV) and all causes among subjects with impaired left ventricular ejection fraction (LVEF; ≤35%) who underwent coronary artery bypass grafting (CABG), 2 an effect that persisted until the end of extended follow-up. 3 Contrary to prior non-randomized studies, 4,5 there was no interaction between the presence of myocardial viability assessed using dobuta-mine stress echocardiography (DSE) and/or single photon emission computed tomography (SPECT) with the treat-Background: Myocardial viability assessment in revascularization of ischemic heart failure remains controversial. This study evaluated the prognostic utility of cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE) in ischemic heart failure.