Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, 10016, USA.
Division of Cardiology, VA Harbor Medical Center, Manhattan Campus, 423 E 23rd Street, 12 West, Cardiology, New York, NY, 10010, USA.
Curr Cardiol Rep. 2021 Jan 4;23(1):5. doi: 10.1007/s11886-020-01433-8.
Myocardial viability is an important pathophysiologic concept which may have significant clinical impact in patients with left ventricular dysfunction due to ischemic heart disease. Understanding the imaging modalities used to assess viability, and the clinical implication of their findings, is critical for clinical decision-making in this population.
The ability of dobutamine echocardiography, single-photon emission computed tomography, positron emission tomography, and cardiac magnetic resonance imaging to predict functional recovery following revascularization is well-established. Despite different advantages and disadvantages for each imaging modality, each modality has demonstrated reasonable performance characteristics in identifying viable myocardium. Recent data, however, has called into question whether this functional recovery leads to improved clinical outcomes. Although the assessment of viability can be used to aid in clinical decision-making prior to revascularization, its broad application to all patients is limited by a lack of data confirming improvement in clinical outcomes. Thus, viability assessments may be best applied to select patients (such as those with increased surgical risk) and integrated with clinical, laboratory, and imaging data to guide clinical care. Future research efforts should be aimed at establishing the impact of viability on clinical outcomes.
心肌存活性是一个重要的病理生理概念，对于因缺血性心脏病导致左心室功能障碍的患者具有重要的临床意义。了解评估存活性的影像学方法及其检查结果的临床意义，对于该人群的临床决策至关重要。
多巴酚丁胺超声心动图、单光子发射计算机断层扫描、正电子发射断层扫描和心脏磁共振成像预测血运重建后功能恢复的能力已得到充分证实。尽管每种影像学方法都有不同的优缺点，但每种方法在识别存活心肌方面都表现出了合理的性能特征。然而，最近的数据质疑这种功能恢复是否能带来临床结局的改善。尽管在血运重建前评估存活能力有助于辅助临床决策，但由于缺乏数据证实临床结局的改善，其广泛应用于所有患者受到限制。因此，存活能力评估可能最适用于选择患者（如手术风险增加的患者），并与临床、实验室和影像学数据相结合，以指导临床治疗。未来的研究工作应旨在确定存活能力对临床结局的影响。
