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Myocardial Viability Assessment — EECC MCQ

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HardCardiac ImagingMyocardial Viability AssessmentEECC

A 58-year-old man with a recent NSTEMI and multivessel CAD undergoes stress perfusion cardiac MRI to guide revascularisation. The study shows a stress-induced perfusion defect in the circumflex territory with matched LGE involving more than 50% of the wall thickness. What does this indicate regarding viability of the circumflex territory?

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Correct answer: E — Non-viable (transmural scar) myocardium unlikely to benefit from revascularisation

Explanation lettering: D = shown as A · E = shown as B · B = shown as C · C = shown as D · A = shown as E

Transmural LGE (above 50% wall thickness) indicates non-viable myocardium unlikely to recover function after revascularisation. The stress perfusion defect is explained by scar rather than jeopardised viable myocardium. Segments with below 50% transmural extent of LGE are considered viable. PET assessment (C) would add little when CMR shows transmural scar. Stunned myocardium (D) would not show LGE. Viable myocardium (A) would have minimal or no LGE.

Reference: BSCI/BSE (2022): Cardiac MRI Assessment of Myocardial Viability