After the Surgical Treatment for Ischemic Heart Failure (STICH) trial was
introduced, it is controversial whether myocardial viability assessment is necessary or
not. Myocardial viability assessment has been regarded as an essential element to select
candidates for revascularization who will benefit from revascularization. However,
viability determination failed to identify the patients with a differential survival benefit
from CABG as compared with medical therapy alone from the sub-study of STICH
trial. F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) assisted
management for patients with severe left ventricular (LV) dysfunction and suspected
coronary artery disease (CAD) also failed to demonstrate a significant reduction in
cardiac events compared with standard care (PARR-2 study). However, a significant
benefit was observed when there was adherence to PET analysis is limited to PET
recommendations. Like this, when the negative report is interpreted carefully, viability
assessment can assign the right patients for the right treatment. To assess viability,
concomitant myocardial jeopardy is essential to evaluate. Endpoints for viability
assessment were regional/global functional recovery, symptom relief, exercise capacity
improvement, reduction of re-hospitalization rate, and prevention of LV remodeling
after revascularization. Some beneficial effects can be obtained in patients with
ischemic LV dysfunction in the presence of viability even if functional recovery was
not demonstrated.
The importance of viability assessment and the similarities and differences of imaging
modalities are discussed in this chapter.
Keywords: FDG-PET, Functional Recovery, Jeopardy, MRI, Viability.
