The Current Role of Viability Imaging to Guide Revascularization and Therapy Decisions in Patients With Heart Failure and Reduced Left Ventricular Function

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Kandolin , R M , Wiefels , C C , Mesquita , C T , Chong , A-Y , Boland , P , Glineur , D , Sun , L , Beanlands , R S & Mielniczuk , L M 2019 , ' The Current Role of Viability Imaging to Guide Revascularization and Therapy Decisions in Patients With Heart Failure and Reduced Left Ventricular Function ' , Canadian Journal of Cardiology , vol. 35 , no. 8 , pp. 1015-1029 . https://doi.org/10.1016/j.cjca.2019.04.029

Title: The Current Role of Viability Imaging to Guide Revascularization and Therapy Decisions in Patients With Heart Failure and Reduced Left Ventricular Function
Author: Kandolin, Riina M.; Wiefels, Christiane C.; Mesquita, Claudio Tinoco; Chong, Aun-Yeong; Boland, Paul; Glineur, David; Sun, Louise; Beanlands, Rob S.; Mielniczuk, Lisa M.
Other contributor: University of Helsinki, HUS Heart and Lung Center


Date: 2019-08
Language: eng
Number of pages: 15
Belongs to series: Canadian Journal of Cardiology
ISSN: 0828-282X
DOI: https://doi.org/10.1016/j.cjca.2019.04.029
URI: http://hdl.handle.net/10138/315201
Abstract: This review describes the current evidence and controversies for viability imaging to direct revascularization decisions and the impact on patient outcomes. Balancing procedural risks and possible benefit from revascularization is a key question in patients with heart failure of ischemic origin (IHF). Different stages of ischemia induce adaptive changes in myocardial metabolism and function. Viable but dysfunctional myocardium has the potential to recover after restoring blood flow. Modern imaging techniques demonstrate different aspects of viable myocardium; perfusion (single-photon emission computed tomography [SPECT], positron emission tomography [PET], cardiovascular magnetic resonance [CMR]), cell metabolism (PET), cell membrane integrity and mitochondrial function (201Tl and 99mTc-based SPECT), contractile reserve (stress echocardiography, CMR) and scar (CMR). Observational studies suggest that patients with IHF and significant viable myocardium may benefit from revascularization compared with medical treatment alone but that in patients without significant viability, revascularization appears to offer no survival benefit or could even worsen the outcome. This was not supported by 2 randomized trials (Surgical Treatment for Ischemic Heart Failure [STICH] and PET and Recovery Following Revascularization [PARR] -2) although post-hoc analyses suggest that benefit can be achieved if decisions had been strictly based on viability imaging recommendations. Based on current evidence, viability testing should not be the routine for all patients with IHF considered for revascularization but rather integrated with clinical data to guide decisions on revascularization of high-risk patients with comorbidities.
Subject: CORONARY-ARTERY-DISEASE
POSITRON-EMISSION-TOMOGRAPHY
CHRONIC TOTAL OCCLUSIONS
CARDIAC RESYNCHRONIZATION THERAPY
QUALITY-OF-LIFE
MYOCARDIAL VIABILITY
HIBERNATING MYOCARDIUM
BYPASS-SURGERY
NATRIURETIC PEPTIDE
MAGNETIC-RESONANCE
3121 General medicine, internal medicine and other clinical medicine
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