Abstract of the day – Can CMR-based myocardial viability assessment be used to guide revascularisation in patients with ischaemic cardiomyopathy?
29 Aug 2025
Abstract of the Day Doctor Antoine Lequipar (Hospital Lariboisiere - Paris, France) will today present a study assessing whether percutaneous coronary intervention (PCI) guided by cardiovascular magnetic resonance (CMR)-based myocardial viability predicts death in patients with ischaemic cardiomyopathy (ICM) and LVEF <50%.
From 2008 to 2022, consecutive patients with ICM referred for CMR-based myocardial viability assessment were included if they had ≥70% stenosis in ≥1 epicardial coronary artery on angiography, a history of myocardial infarction or prior coronary revascularisation and LVEF <50%. Data were collected on PCI within 90 days of the index CMR. The primary outcome was all-cause death. Myocardial viability was evaluated using ischaemic late gadolinium enhancement (LGE) transmurality, assessed based on maximal scar depth, and categorised into <50%, 50–74% and ≥75% LGE transmurality. Multivariable Cox regression analysis was used to determine the prognostic value of PCI guided by myocardial viability.
The study population included 6,082 patients who had a mean age of 65 years and were 73% male. Of the total population, 59% exhibited ischaemic LGE and 46% underwent PCI within 90 days of CMR. PCI was performed in 89% of patients with <50% LGE transmurality, 81% of patients with 50–74% LGE transmurality and 6% of patients with ≥75% LGE transmurality. Over a median follow-up of 9 years, 11% of the total population had died.
Among patients with <50% LGE transmurality who underwent PCI, mortality risk was similar to those without LGE (hazard ratio [HR] 0.92; 95% CI 0.66 to 1.28; p=0.625). Of note, among patients with <50% LGE transmurality, those without PCI had a significantly higher risk of death than those with PCI (HR 2.42; 95% CI 1.55 to 3.80; p<0.001).
Interestingly, in patients with 50–74% LGE transmurality, patients with PCI had significantly better survival rates than those without PCI (odds ratio [OR] 0.58; 95% CI 0.43 to 0.74; p<0.001). In patients with ≥75% LGE transmurality, survival rates were similar, with or without PCI (OR 0.81; 0.44 to 1.49; p=0.50).
The authors conclude that in this large cohort of consecutive ICM patients, revascularisation with PCI in patients with <50% and 50–74% of CMR-assessed myocardial LGE transmurality was beneficial and associated with improved survival outcomes.
