In search of myocardial viability 20 years later: Methodology, clinical applications and implications

Identification of reversible or non-reversible left ventricular dysfunction in patients with chronic myocardial dysfunction yields relevant clinical implications. The benefit of revascularizing a non-contractile, but alive viable myocardium is still object of discussion. In this article, the issue of viability is approached from two perspectives: 1) review of methods that have been developed to identify potentially reversible myocardial dysfunction, and 2) evaluation of the risk-benefit ratio of coronary revascularization in dysfunctional myocardium. In fact, albeit coronary revascularization of viable myocardium should be always considered mandatory, revascularization of apparently non-viable myocardium is still debated since it could improve the overall myocardial function and, therefore, improve prognosis. In this article, the principal methods to detect the residual myocardial viability, their relative advantages or limitations and their clinical implication will be discussed.