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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dc.contributor.author Kandolin, Riina M.
dc.contributor.author Wiefels, Christiane C.
dc.contributor.author Mesquita, Claudio Tinoco
dc.contributor.author Chong, Aun-Yeong
dc.contributor.author Boland, Paul
dc.contributor.author Glineur, David
dc.contributor.author Sun, Louise
dc.contributor.author Beanlands, Rob S.
dc.contributor.author Mielniczuk, Lisa M.
dc.date.accessioned 2020-05-23T22:23:15Z
dc.date.available 2021-12-18T03:45:54Z
dc.date.issued 2019-08
dc.identifier.citation 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
dc.identifier.other PURE: 127503931
dc.identifier.other PURE UUID: fec4d583-6941-4cc1-9874-732d152d73d5
dc.identifier.other WOS: 000477933900009
dc.identifier.uri http://hdl.handle.net/10138/315201
dc.description.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. en
dc.format.extent 15
dc.language.iso eng
dc.relation.ispartof Canadian Journal of Cardiology
dc.rights cc_by_nc_nd
dc.rights.uri info:eu-repo/semantics/openAccess
dc.subject CORONARY-ARTERY-DISEASE
dc.subject POSITRON-EMISSION-TOMOGRAPHY
dc.subject CHRONIC TOTAL OCCLUSIONS
dc.subject CARDIAC RESYNCHRONIZATION THERAPY
dc.subject QUALITY-OF-LIFE
dc.subject MYOCARDIAL VIABILITY
dc.subject HIBERNATING MYOCARDIUM
dc.subject BYPASS-SURGERY
dc.subject NATRIURETIC PEPTIDE
dc.subject MAGNETIC-RESONANCE
dc.subject 3121 General medicine, internal medicine and other clinical medicine
dc.title The Current Role of Viability Imaging to Guide Revascularization and Therapy Decisions in Patients With Heart Failure and Reduced Left Ventricular Function en
dc.type Review Article
dc.contributor.organization HUS Heart and Lung Center
dc.contributor.organization Kardiologian yksikkö
dc.contributor.organization University of Helsinki
dc.description.reviewstatus Peer reviewed
dc.relation.doi https://doi.org/10.1016/j.cjca.2019.04.029
dc.relation.issn 0828-282X
dc.rights.accesslevel openAccess
dc.type.version acceptedVersion
dc.type.version publishedVersion

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