Evaluation of patients with chronic ischaemic left ventricular dysfunction - assessment of tissue viability

There is growing interest in the assessment of myocardial viability in patients with ischaemic left ventricular dysfunction, in an attempt to identify those patients most likely to show functional improvement post-revascularization. Various techniques, focusing on different 'viability characteristics', are currently available. Of these, myocardial perfusion imaging (MPI) and dobutamine stress echocardiography are used most often; however, nuclear imaging techniques are more sensitive for the assessment of viable tissue. Revascularization of patients with viable tissue has been shown to improve function, reduce heart failure symptoms, improve exercise capacity and improve survival compared with patients with viable myocardium treated medically. Thus, assessment of viability using MPI may guide optimal management of patients with ischaemic left ventricular dysfunction.