Khaldoun TG, Brunken R, McCarthy PM, et al. Myocardial viability testing and the effect of early intervention in patients with advanced left ventricular systolic dysfunction. Circulation. 2006; 113:230-237.

In a study of patients with severe systolic heart failure, early treatment with percutaneous coronary intervention (PCI) or coronary artery bypass graft greatly improved survival compared with medical therapy. According to the article, the pros and cons of revascularization in this patient population have been unclear. While revascularization can potentially reverse left ventricular dysfunction, it has been less clear if this outweighs the perioperative risks and whether the long-term outcomes actually improve. Still, there has been evidence that positron emission tomography (PET)/FDG imaging can identify patients who would benefit from revascularization. Investigators compared the survival of 153 patients treated with PCI or open-heart surgery within 6 months of PET/FDG imaging with that of 153 similar patients who received only medical therapy. These subjects were matched from a larger group of 765 consecutive patients, all of whom had advanced left ventricular systolic dysfunction, defined as an ejection fraction not exceeding 35%. During a median follow-up period of 3 years, 84 patients died. The 3-year mortality rate in the PCI/surgery group was 15% less than one-half the 35% rate seen in the medical group (P = 0.0004). Moreover, a survival benefit was observed regardless of the degree of cardiac tissue viability. The encouraging results from this study open the door for a large-scale, randomized trial, which is currently needed.