Predicting myocardial viability from surface ECG following MI

Once upon a time, long, long ago, cardiologists used to be worried about akinetic segments, scars, dead tissue, and Q waves before attempting revascularization by either PCI or CABG. Now, the concept of myocardial viability has become a cliché ( rather demeaning) at least within the cath labs. Currently ,we follow a self administered whip . Every post-MI patient should be considered for revascularization as a default strategy irrespective of the level of dysfunction or scarring .This can happen either in the IRA territory or non-IRA territory or both. This strategy is now dis-armed with fresh evidence in the form of REVIVE -BRICS trial. There could be some distinct errors in the way many Interpreted this study. (Read here about REVIVE tral Perera D, Ryan et al JAMA Cardiol. 2023) Lets go back and learn something from the year 1999 For those cardiologists who still think myocardial viability is an important factor before revascularization, let me pull out a 30 year-old study from the University of Aberdeen, UK, that looked into the humble ECG to detect viability. The authors went beyond just observing presence or absence of Q waves .It conveys a great learning point. Modified from Al-Mohammad A, et al Heart. 1999 Dec;82(6):663-7. (Ref 1)  Matching means non-viable myocardium  (Tissue looks akinetic or scar-like, while PET concurs and shows lack of metabolic activity. This is referred to as matching, and the segment is non-viable) Mismatch means via...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: Uncategorized acc aha esc guidelines ECG predictors of myocardial viablity PET SCAN FOR VIABLITY REVIVE BRICS STUDY Source Type: blogs