title: Can Functional Testing for Ischemia and Viability Guide Revascularization?
abstract: Cardiac imaging procedures are a cornerstone of the diagnosis and management of patients with cardiac disease. The optimal management of the patient with stable ischemic heart disease or ischemic heart failure often rests on the totality of symptom burden, patient risk, and disease severity, whether assessed anatomically or functionally. Recent trials have demonstrated the power of flow measurements to direct revascularization as well as the strengths and limitations of ischemia and viability/hibernation imaging as markers of risk to direct interventions. They have also highlighted the challenges in evaluating imaging or functional testing to direct therapies, because imaging does not directly affect outcome itself, rather it affects the management decisions that may result in a positive outcome. Ongoing studies with randomized designs, such as FAME 3 (Fractional Flow Reserve versus Angiography for Multivessel Evaluation), ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches), and AIMI-HF (Alternative Imaging Modalities in Ischemic Heart Failure) (IMAGE-HF [Imaging Modalities to Assist with Guiding Therapy in The Evaluation of Patients with Heart Failure]), will provide the highest level of evidence to support practice changes that may further clarify the role of cardiac imaging in the evaluation of these patients and result in improved patient outcomes.
authors.affiliation: Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada. Electronic address: lmielniczuk@ottawaheart.ca.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Mielniczuk
authors.affiliation: University Heart Centre Graz, Graz, Austria.
authors.forename: Gabor G
authors.initials: GG
authors.lastname: Toth
authors.affiliation: Cardiovascular Center Aalst, Aalst, Belgium.
authors.forename: Joe X
authors.initials: JX
authors.lastname: Xie
authors.affiliation: Division of Cardiology, Emory University School of Medicine Atlanta, Georgia.
authors.forename: Bernard
authors.initials: B
authors.lastname: De Bruyne
authors.affiliation: Cardiovascular Center Aalst, Aalst, Belgium.
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.affiliation: Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada.
authors.forename: Rob S
authors.initials: RS
authors.lastname: Beanlands
mesh_terms: D057791:Cardiac Imaging Techniques; D000066491:Clinical Decision-Making; D003661:Decision Support Techniques; D006801:Humans; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D009204:Myocardial Revascularization / Q000379:methods*; D009206:Myocardium / Q000473:pathology*; D018579:Patient Selection; D011237:Predictive Value of Tests; D013997:Time Factors; D014022:Tissue Survival; D016896:Treatment Outcome
keywords: PET; coronary revascularization; fractional flow reserve; heart failure; ischemic heart disease