Eduardo Gomes Lima et al. Eduardo Bello Martins Leticia Neves Solon Carvalho Diogo Freitas Cardoso de Azevedo
Within the clinical spectrum of chronic coronary syndrome (CCS), the presence of coronary artery disease (CAD) alongside ventricular dysfunction has long been a focal point due to the lower survival rates seen in this population. Improving survival in these patients, whether through medications or interventions, is a key concern for clinical cardiologists. Previous observational studies suggested that myocardial viability (MV) could influence the effectiveness of revascularization strategies in patients with ventricular dysfunction. Thus, viability assessment became a standard practice in cardiology. Different imaging methods assess viability through different parameters (such as cell membrane integrity, mitochondrial function, glycolytic metabolism, contractile reserve, or evidence of fibrosis), leading to differing sensitivities and specificities. However, recent evidence from large randomized studies does not support the notion that the presence of MV, as determined by various methods, is linked to the prognostic benefit of revascularization. Furthermore, the reduction in mortality observed in these studies was not attributed to the recovery of contractile function but rather to a decrease in fatal heart attacks. As a result, the current role of MV as a decision-making tool for revascularization in patients with CCS and left ventricular dysfunction has diminished. Nonetheless, there are still situations in specialist practice where its use may be warranted, particularly in the context of constructing a comprehensive functional revascularization strategy.
