Myocardial Scar Imaging: Viability Beyond REVIVED

Kiberu, Yusuf; Jathanna, Nikesh; Narayanan, Nithin; Vanezis, Andrew P.; Erhayiem, Bara; Graham, Adam; Jamil-Copley, Shahnaz

Abstract

Purpose of Review: It was previously believed that the presence of myocardial viability in patients with significant coronary artery disease improved outcomes following revascularisation, but the landmark STITCH trial found no significant correlation between viability and overall survival. However, the study used single photon emission contrast tomography or dobutamine stress echocardiography for viability assessment, but late gadolinium enhanced cardiac magnetic resonance imaging (LGE-CMR) has since become the gold standard for viability assessment. Additionally, there has been significant progress in heart failure pharmacotherapy. Leveraging these advances, the REVIVED study authors revisited the role of revascularisation on heart failure patient clinical outcomes. Similar to the STITCH study, REVIVED also identified a lack of correlation between viability and outcomes, confirming its limited role in revascularisation decision making. The purpose of this review is to discuss the advances in myocardial viability imaging and the role of LGE-CMR scar assessment beyond the REVIVED study. Recent Findings: Myocardial scar predisposes to ventricular arrythmias and sudden cardiac death (SCD). It is the authors’ opinion that beyond REVIVED, focus should be placed on optimising the management of ventricular arrhythmias through visualisation and characterisation of cardiac scar to improve clinical outcomes. A significant proportion of SCDs occur in patients who remain unprotected if guided by current recommendations. Several studies have confirmed the presence and burden of scar as a better predictor of clinical outcomes in comparison to the current gold standard of left ventricular ejection fraction (LVEF). Summary: The potential of machine learning and radiomics to visualise cardiac anatomy and characterise scar, leveraged with the ability to integrate segmented CMR and clinical electroanatomic maps intraoperatively shows promise in improving outcomes in VT ablations and delivering precision treatment based on individual risk.

Citation

Kiberu, Y., Jathanna, N., Narayanan, N., Vanezis, A. P., Erhayiem, B., Graham, A., & Jamil-Copley, S. (2024). Myocardial Scar Imaging: Viability Beyond REVIVED. Current Cardiovascular Imaging Reports, 17, 107–114. https://doi.org/10.1007/s12410-024-09597-5

• Journal Article Type: Review
• Acceptance Date: Sep 24, 2024
• Online Publication Date: Oct 10, 2024
• Publication Date: Oct 10, 2024
• Deposit Date: Oct 10, 2024
• Publicly Available Date: Oct 10, 2024
• Journal: Current Cardiovascular Imaging Reports
• Print ISSN: 1941-9066
• Electronic ISSN: 1941-9074
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 17
• Pages: 107–114
• DOI: https://doi.org/10.1007/s12410-024-09597-5
• Keywords: Myocardial scar imaging; Late gadolinium enhanced cardiac magnetic resonance; Revascularisation; Left ventricular ejection fraction; Ventricular tachycardia; Sudden cardiac death
• Public URL: https://nottingham-repository.worktribe.com/output/40562465
• Publisher URL: https://link.springer.com/article/10.1007/s12410-024-09597-5