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February 8, 2026European Heart Journal

Impact of the LGE granularity to guide coronary revascularisation in ischaemic cardiomyopathy

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Why the study?

The role of CMR in guiding coronary revascularisation based on myocardial viability remains debated, particularly after the REVIVED trial.

Does coronary revascularisation reduce all-cause mortality in patients with ischaemic cardiomyopathy and viable myocardium assessed by CMR LGE granularity?

Population

1,698 ICM patients with LVEF <50% and viable myocardium referred for CMR viability assessment

Comparison

Revascularisation within 90 days vs no revascularisation

Design

Retrospective analysis of a multicentre study

Follow-up

Median 8.9 years

Key result

Revascularisation in ischemic cardiomyopathy patients with viable myocardium reduced mortality by 72% (HR 0.28) over ~9 years, especially with moderate LGE extent and antero-septal LGE.

Authors

AUA UngerSTS ToupinSDSuzanne Duhamel

Discussion

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Overview

Supports viability-guided revascularisation in ischaemic cardiomyopathy; extends observational data but leaves open RCT confirmation.

Key Points

  • To evaluate the predictive value of CMR-guided coronary revascularisation based on LGE granularity for mortality in ischaemic cardiomyopathy patients.
  • Retrospective analysis of a multicentre study from 2008 to 2022
  • Included ischaemic cardiomyopathy patients with LVEF <50% and viable myocardium
  • Collected data on LGE parameters and revascularisation status within 90 days
  • Primary endpoint was all-cause mortality
  • Used Cox proportional hazards regression for analysis.
  • Among 1,698 patients, 88% underwent revascularisation within 90 days
  • Mean follow-up was 8.9 years with 4.7% all-cause mortality
  • Revascularisation significantly reduced mortality (HR: 0.28)
  • Particularly effective for patients with moderate LGE extent (3–5 segments) and antero-septal LGE.

Structured PICO

Does coronary revascularisation reduce all-cause mortality in patients with ischaemic cardiomyopathy and viable myocardium assessed by CMR LGE granularity?

P
Population
1,698 patients with ischaemic cardiomyopathy (ICM), reduced LVEF <50%, and viable myocardium (ischaemic-LGE transmurality <50%), mean age 64, 74% male. Key inclusion: ≥70% stenosis in ≥1 epicardial coronary artery, prior myocardial infarction, or previous coronary revascularization.
I
Intervention
Coronary revascularisation within 90 days of cardiovascular magnetic resonance (CMR)
C
Comparator
No coronary revascularisation within 90 days of CMR
O
Outcome
All-cause mortalityhard clinical

CMR-guided coronary revascularisation based on LGE granularity is associated with improved long-term survival in ischaemic cardiomyopathy patients with viable myocardium, particularly those with moderate LGE extent and antero-septal distribution.

Cite This Study

Unger et al. (2025) studied this question. Revascularisation in ischemic cardiomyopathy patients with viable myocardium reduced mortality by 72% (HR 0.28) over ~9 years, especially with moderate LGE extent and antero-septal LGE.

synapsesocial.com/papers/6988290a0fc35cd7a884908ahttps://doi.org/10.1093/eurheartj/ehaf784.275
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