Myocardial viability: whom, what, why, which, and how?

Viability imaging might be useful to guide decisions for revascularization in patients with ischemic cardiomyopathy. Recent trial results raise important points for clinicians regarding which modalities to use and in which patients. We discuss the modalities currently used in clinical practice. We suggest that testing be reserved for complex patients in whom the risks and potential benefits from revascularization are highest, and emphasize that the results of viability testing are not the only determinant of potential outcome benefit, and should not be viewed in isolation but as an objective adjunct to decision making.