Foreword

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A 64-year-old diabetic man presents with recurrent chest pain and dyspnea on exertion. He is 10 years post three-vessel coronary artery bypass graft surgery and he has a left ventricular ejection fraction of 20% by radionuclear ventriculography. Coronary arteriography showed occluded vein bypass grafts to the left circumflex coronary artery and the obtuse marginal branch. There are two 50% mid right coronary artery stenoses and a lima graft to the left anterior descending coronary artery is open. He has been on optimal medical therapy but is symptomatic at rest.

The primary questions are the following: (1) Is this man a surgical candidate? and (2) what are the likely results of surgery? This is a common situation. If there is ischemic but still viable myocardium supplied by operable coronary arteries, he may benefit markedly by coronary artery bypass graft. If not, he is unlikely to improve postoperation and may even be an early postoperative death.

For this reason, there has been an expanded use of noninvasive techniques to assess the presence or absence of viable myocardium in patients with marked depression of the left ventricular function due to ischemic heart disease. In this issue of Current Problems in Cardiology, Dr. Schinkel and his coauthors revisit a pooled analysis of the available data concerning noninvasive imaging techniques for determining the presence of viable myocardium. The current report is an update of this pooled analysis with inclusion of all studies between 2001 and 2007. The positive- and negative-predictive values are given for noninvasive tests and their analysis emphasizes the importance of determining the presence or absence of viable ischemia. One of the authors (S.H.R.) was the first to accurately define the concept of the hibernating myocardium. The editorial board is grateful to Dr. Schinkel and his associates for updating the large volume of data on this topic and to Dr. Robert Bonow for his editorial comments.