The viable myocardium: epidemiology, detection, and clinical implications

Lancet. 1998 Mar 14;351(9105):815-9. doi: 10.1016/S0140-6736(97)08080-X.


The success of fibrinolytic and other therapies has reduced the mortality of myocardial infarction. However, many survivors develop congestive heart failure. Medical treatment of this disorder has limited efficacy, and cardiac transplantation has limited availability. Contrary to previous teaching about ischaemic injury, roughly 40% of segments involved in myocardial infarction may subsequently recover, either spontaneously or after revascularisation. The persistence of such viable myocardium means that previous approaches to treatment of myocardial infarction must be reappraised. This review examines the pathogenesis of this response, the techniques that may be used to identify the salvageable tissue, and the clinical implications. Myocardial revascularisation may improve symptom status, exercise capacity, and prognosis in selected patients with viable myocardium.

Publication types

  • Review

MeSH terms

  • Heart Failure* / diagnosis
  • Heart Failure* / epidemiology
  • Heart Failure* / etiology
  • Humans
  • Myocardial Infarction / complications*
  • Myocardial Infarction / therapy
  • Myocardial Revascularization
  • Myocardial Stunning* / diagnosis
  • Myocardial Stunning* / epidemiology
  • Myocardial Stunning* / etiology
  • Prognosis
  • Ventricular Dysfunction, Left / diagnosis
  • Ventricular Dysfunction, Left / epidemiology
  • Ventricular Dysfunction, Left / etiology