title: Role of viability imaging in the post-STICH era.
abstract: OBJECTIVE
  Recent results from prospective randomized controlled trials examining the management of patients with ischemic cardiomyopathy (ICM) have questioned both the added value of revascularization over contemporary optimal medical therapy (OMT) and the use of viability testing as a gate-keeper to revascularization. The purpose of this review is to summarize recent trial evidence before discussing future perspectives in the field.
  
  
  RESULTS
  The Surgical Treatment of Ischemic Heart Failure (STICH) trial, PPAR-2 trial and Heart Failure Revascularisation Trial have all reported their results within the past 5 years. None of these trials found revascularization superior to OMT in improving survival of ICM patients. Additionally, the STICH trial's viability substudy suggested that pretreatment viability testing was not beneficial.
  
  
  CONCLUSIONS
  ICM patients remain a clinical conundrum. The numerous limitations of the recent RCTs have led to uncertainty about optimal management. Revascularization continues to be offered to patients with evidence of myocardial viability. Further studies are required to answer the outstanding questions in the management of patients with ICM.
authors.affiliation: aDepartment of Cardiology, Royal Brompton Hospital bCardiovascular Biomedical Research Unit, Royal Brompton Hospital cNational Heart and Lung Institute, Imperial College, London, UK.
authors.forename: Benoy Nalin
authors.initials: BN
authors.lastname: Shah
authors.forename: Roxy
authors.initials: R
authors.lastname: Senior
mesh_terms: D057791:Cardiac Imaging Techniques / Q000639:trends; D006801:Humans; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000601:surgery*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic / Q000639:trends; D014022:Tissue Survival