Current Role of Myocardial Viability Imaging Using Positron Emission Tomography in Patients with Chronic Ischemic Heart Failure and Left Ventricular Dysfunction

Purpose of Review It is currently debated what role cardiac viability imaging plays in clinical practice, as newer randomized studies have refuted the previously reported beneficial effects of non-invasive imaging-guided decision-making for revascularization. This review provides an overview of previous literature and recent findings on the clinical use of viability PET imaging in revascularization decision-making for patients with chronic ischemic heart failure. Recent Findings Recent studies have concluded that preoperative myocardial viability assessment by PET imaging does not have significant predictive value for outcomes following revascularization in patients with ischemic heart failure. Alternative PET metrics, e.g., myocardial flow reserve obtained through a less time-consuming protocol compared to FDG PET, have the potential to predict revascularization outcomes. Summary Viability assessment prior to revascularization may not be as significant in clinical practice as it was previously thought. This shift in perspective is likely due to the retrospective nature of earlier studies, coupled with the progress made in heart failure treatment.