Myocardial Viability: Reversible Left Ventricular Dysfunction

Abstract

The objective of myocardial viability assessment is to identify prospectively patients with potentially reversible left ventricular dysfunction in whom prognosis may be favorably altered with coronary artery revascularization. The concept that impaired left ventricular function at rest may be reversible after revascularization is now well established. Pathophysiologic paradigms have emerged that describe the relationships between myocardial perfusion and ventricular function, leading to the concepts of stunning and hibernation. In these paradigms, myocardial function is depressed but myocytes remain viable, and therefore left ventricular dysfunction may be completely reversible. Considerable advances in basic research and clinical science since the 1980s have helped clarify the underlying mechanisms of the functional alterations in stunned and hibernating myocardium. These advances have altered clinical practice and have led to improved patient management and survival. However, despite significant advances in our understanding and medical management of patients with left ventricular dysfunction, the prevalence of heart failure and the resultant death rates have almost tripled since the 1970s.