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July 8, 2026Current Opinion in Cardiology

Viability testing fails to predict survival after revascularization, while scar quantification offers greater prognostic value.

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Why the study?

Recent trials challenged the assumption that viability predicts functional recovery and improved survival after revascularization, highlighting the need to re-evaluate viability testing alongside contemporary revascularization and guideline-directed medical therapy.

Does myocardial viability testing improve survival and functional recovery in patients with ischemic cardiomyopathy undergoing revascularization?

Design

Review

Key result

Myocardial viability testing does not independently predict survival benefit from revascularization in ischemic cardiomyopathy, whereas scar quantification may offer greater prognostic utility.

Authors

KLKevin Y. LiNDNitish K. DhingraRPRaumil Patel

Discussion

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Overview

Viability testing may not guide revascularization in ischemic cardiomyopathy; challenges traditional assumptions and leaves open its role with modern therapies.

Key Points

  • The study aims to reassess the role of myocardial viability testing in guiding revascularization decisions for ischemic cardiomyopathy patients.
  • Reviewed findings from recent trials including STICH and REVIVED-BCIS2.
  • Analyzed the impact of viability and scar burden on patient outcomes.
  • Discussed the implications of imaging techniques like CMR on viability assessment.
  • CABG was shown to improve long-term survival regardless of viability status (STICH trial).
  • PCI did not demonstrate a survival benefit in patients with viable myocardium (REVIVED-BCIS2).
  • Scar burden emerged as a stronger predictor of adverse outcomes than viability presence.

Structured PICO

Does myocardial viability testing improve survival and functional recovery in patients with ischemic cardiomyopathy undergoing revascularization?

P
Population
Patients with ischemic cardiomyopathy
E
Exposure
Myocardial viability testing to guide revascularization
O
Outcome
Survival and functional recovery

This review highlights that contemporary trial data challenges the traditional use of myocardial viability testing to guide revascularization, suggesting a shift towards scar quantification.

Cite This Study

Li et al. (2026) conducted a review in ischemic cardiomyopathy. Myocardial viability testing was evaluated. Myocardial viability testing does not independently predict survival benefit from revascularization in ischemic cardiomyopathy, whereas scar quantification may offer greater prognostic utility.

synapsesocial.com/papers/6a4de835d2ea289ef6282f9fhttps://doi.org/10.1097/hco.0000000000001329
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