Viability testing to guide myocardial revascularisation in patients with heart failure

Figures

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  Fig. 1. Adjusted Kaplan-Meier survival analysis of all-cause death with early revascularisation (ER) versus medical therapy (MT), according to the percentage of hibernating myocardium: 5% (a), 10% (b), 15% (c) and 20% (d). Equipoise between MT and ER is reached at 10% of hibernating myocardium. With greater levels of hibernating myocardium, there is a survival benefit associated with ER. Reproduced from Ling et al. with permission [26]

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  Fig. 2. Flow chart for use of viability testing in patients with ischaemic cardiomyopathy. In patients fit for revascularisation, up-to-date assessment of coronary anatomy should be undertaken by coronary angiography. Where revascularisation can be undertaken, viability imaging should be performed. In patients with a large burden of hibernating myocardium, short-term procedural risk may be justifiable to improve long-term outcome. The optimal mode of revascularisation should be assessed by a heart team. Modified from Perera & Redwood with permission [40]