Myocardial Viability and Remodeling: Does Size Matter?

I schemic heart disease with resultant left ventricular (LV) dysfunction is the major underlying cause of heart failure and carries significant morbidity and mortality. Therapeutic endeavors to improve the prognosis of these patients have evolved over the years and include a multifaceted approach aimed at alleviating symptoms and improving ventricular function, and reducing reinfarction and sudden death, using multidrug therapy, revascularization procedures, implantable cardioverter-defibrillators and resynchronization devices. Over the past 40 years, with the introduction of the concept of myocardial viability and reversibility of LV function with revascularization and medical therapy, numerous investigations have attempted to identify how best to detect viability, particularly with various imaging modalities, and identify the most suitable candidates for revascularization with the aim to reverse remodeling, enhance ventricular function, and improve overall prognosis. Prior to the STICH (Surgical Treatment for Ischemic Heart Failure) trial (1,2), numerous tacitly proved notions were widely believed: