Patients with ischaemic left ventricular dysfunction frequently undergo myocardial viability testing. The historical model presumes that those who have extensive areas of dysfunctional-yet-viable myocardium derive particular benefit from revascularization, whilst those without extensive viability do not. These suppositions rely on the theory of hibernation and are based on data of low quality: taking a dogmatic approach may therefore lead to patients being refused appropriate, prognostically important treatment. Recent data from a sub-study of the randomized STICH trial challenges these historical concepts, as the volume of viable myocardium failed to predict the effectiveness of coronary artery bypass grafting. Should the Heart Team now abandon viability testing, or are new paradigms needed in the way we interpret viability? This state-of-the-art review critically examines the evidence base for viability testing, focusing in particular on the presumed interactions between viability, functional recovery, revascularization and prognosis which underly the traditional model. We consider whether viability should relate solely to dysfunctional myocardium or be considered more broadly and explore wider uses of viability testingoutside of revascularization decision-making. Finally, we look forward to ongoing and future randomized trials, which will shape evidence-based clinical practice in the future.

中文翻译：

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心肌活力测试：全部完成，还是即将恢复？

缺血性左心室功能障碍患者经常接受心肌活力测试。历史模型假定，那些具有广泛功能障碍但仍有活力的心肌区域的人从血运重建中获得了特别的好处，而那些没有广泛活力的人则没有。这些假设依赖于冬眠理论并且基于低质量的数据：因此采取教条主义的方法可能会导致患者被拒绝适当的、对预后重要的治疗。来自随机 STICH 试验的一项子研究的最新数据挑战了这些历史概念，因为存活心肌的体积未能预测冠状动脉旁路移植术的有效性。如果心脏小组现在放弃活力测试，还是我们解释可行性的方式需要新的范式？这篇最先进的综述批判性地检查了活力测试的证据基础，特别关注传统模型下的活力、功能恢复、血运重建和预后之间假定的相互作用。我们考虑生存能力是否应该仅与功能失调的心肌相关或更广泛地考虑，并探索在血运重建决策之外更广泛地使用生存能力测试。最后，我们期待正在进行和未来的随机试验，这些试验将在未来塑造循证临床实践。传统模型下的血运重建和预后。我们考虑生存能力是否应该仅与功能失调的心肌相关或更广泛地考虑，并探索在血运重建决策之外更广泛地使用生存能力测试。最后，我们期待正在进行和未来的随机试验，这些试验将在未来塑造循证临床实践。传统模型下的血运重建和预后。我们考虑生存能力是否应该仅与功能失调的心肌相关或更广泛地考虑，并探索在血运重建决策之外更广泛地使用生存能力测试。最后，我们期待正在进行和未来的随机试验，这些试验将在未来塑造循证临床实践。