Viability assessment before surgical revascularization in patients with severe left ventricular dysfunction

BACKGROUND

Myocardial viability testing in contemporary practice remains controversial.

Recent ESC/EACTS guidelines indicate that myocardial viability testing for patients with reduced left ventricular systolic function should be given a IIb indication before decision on coronary revascularization. This study describes our Heart team experience utilizing myocardial viability testing by SPECT myocardial perfusion imaging (MPI), as well as midterm outcomes.

METHODS

Between 2014-2018 71 candidates for coronary artery bypass grafting (CABG), with left ventricular ejection fraction (LVEF) of ≤35% (Mean 22%±0.08), underwent SPECT MPI. Patients were referred for CABG or percutaneous coronary intervention (PCI) after Heart team discussion. The primary end point was death from any cause. The median duration of follow up was 32months.

RESULTS

56% (40 patients) had significant myocardial viability, of these 4 patients refused surgery and 2 patients were declined by the surgeons due to high surgical risk. 34(47.8%) patients underwent CABG and 37(52.1%) underwent PCI to viable territories. During a median follow up of 32 months (range 13-68months) 16 patients (22.5%) died (mean age 69±10 years; mean LVEF 19%±0.9), of which 3 (8.8%) from the surgical arm and 13(35%) from the PCI arm (p<0.05).

CONCLUSIONS

Myocardial viability testing with SPECT MPI can improve Heart team decision making in patients with severe left ventricular dysfunction. Although this practice is still controversial, it may identify patients who would not benefit from surgery.