Myocardial viability testing: all STICHed up, or about to be REVIVED?

Ryan, M., Morgan, H., Chiribiri, A., Nagel, E., Cleland, J. and Perera, D. (2022) Myocardial viability testing: all STICHed up, or about to be REVIVED? European Heart Journal, 43(2), pp. 118-126. (doi: 10.1093/eurheartj/ehab729) (PMID:34791132) (PMCID:PMC8757581)

Abstract

Patients with ischaemic left ventricular dysfunction frequently undergo myocardial viability testing. The historical model presumes that those who have extensive areas of dysfunctional-yet-viable myocardium derive particular benefit from revascularization, whilst those without extensive viability do not. These suppositions rely on the theory of hibernation and are based on data of low quality: taking a dogmatic approach may therefore lead to patients being refused appropriate, prognostically important treatment. Recent data from a sub-study of the randomized STICH trial challenges these historical concepts, as the volume of viable myocardium failed to predict the effectiveness of coronary artery bypass grafting. Should the Heart Team now abandon viability testing, or are new paradigms needed in the way we interpret viability? This state-of-the-art review critically examines the evidence base for viability testing, focusing in particular on the presumed interactions between viability, functional recovery, revascularization and prognosis which underly the traditional model. We consider whether viability should relate solely to dysfunctional myocardium or be considered more broadly and explore wider uses of viability testingoutside of revascularization decision-making. Finally, we look forward to ongoing and future randomized trials, which will shape evidence-based clinical practice in the future.

• Item Type: Articles
• Additional Information: M.R. is supported via British Heart Foundation (BHF) Clinical Research Training Fellowship (FS 18/16/33396). H.M. is supported by the British Heart Foundation via a pump-prime grant from the British Heart Foundation Centre of Research Excellence at King’s College London (RE16349).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cleland, Professor John
• Authors: Ryan, M., Morgan, H., Chiribiri, A., Nagel, E., Cleland, J., and Perera, D.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: European Heart Journal
• Publisher: Oxford University Press
• ISSN: 0195-668X
• ISSN (Online): 1522-9645
• Published Online: 13 November 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in European Heart Journal 43(2): 118-126
• Publisher Policy: Reproduced under a Creative Commons License