(Circulation. 1995;92:2790-2793.)
© 1995 American Heart Association, Inc.
Articles |
There May Be More to Myocardial Viability Than Meets the Eye!
From the Cardiovascular Division, University of Virginia School of Medicine, Charlottesville.
Correspondence to Sanjiv Kaul, MD, Cardiovascular Division, University of Virginia Medical Center, Box 158, Charlottesville, VA 22908.
Key Words: myocardium • contractility • Editorials
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Introduction |
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According to the Oxford English Dictionary, "viable" means "capable of living."1 Incorrectly, the terms viable and capable of contracting in the presence of adequate blood flow have been used interchangeably for the myocardium. Consequently, it has been suggested that viable myocardium is only that which demonstrates improved thickening after restoration of blood flow.2
This definition of viability is inaccurate because it ignores a
fundamental physiological principle: that at rest,
most left ventricular wall thickening occurs as a result of
endocardial thickening; the middle layer of the myocardium
contributes only modestly to thickening; and the contribution of the
epicardium is negligible (Fig 1
).3 4
Thus,
if the endocardium is necrosed, wall thickening will be significantly
diminished at rest even if blood flow is restored to the middle and
outer thirds of the ventricular wall.5 When
infarction involves <20% of the wall thickness, hypokinesia is noted.
When it involves 
20% of the wall thickness, akinesia or dyskinesia
is seen.6
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Defining viability as recovery in regional function after revascularization also presupposes that revascularization successfully restores resting nutrient blood flow to normal levels. It ignores the all too frequent occurrence of inadequate revascularization for technical reasons, poor distal runoff, or the presence of abnormal microvasculature within the revascularized bed.7
Thus, defining viability
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