European Association of Cardiovascular Imaging survey on imaging for myocardial viability.

Aims: To evaluate the current role and practice patterns in myocardial viability assessment through a European Association of Cardiovascular Imaging (EACVI) survey. Methods and results: A total of 179 participants from 54 countries completed the survey. Most participants worked in tertiary centres (60.3%). Transthoracic echocardiography (TTE) was the most widely available modality (98.3%), followed by stress echocardiography (86.6%), cardiac computed tomography angiography (87.7%), and cardiovascular magnetic resonance (CMR, 84.9%). Single-photon emission computed tomography and positron emission tomography were less accessible (59.8 and 40.2%, respectively). CMR was the preferred imaging modality (76.0%), followed by TTE (41.9%), which were also the most frequently used techniques in clinical practice (42.7 and 38.7%, respectively). Viability imaging was regularly used by most respondents in patients with chronic ischaemic heart disease (57.0%) and prior to revascularization for chronic total occlusions (58.7%). Among late-presenting ST-elevation myocardial infarction patients, 60.7% of respondents assessed viability within index hospitalization or the first month, whereas 28.3% performed viability imaging after 1-3 months. However, considerable variation exists between respondents. Revascularization decisions were guided by viability findings with revascularization of only viable segments in 49.1% of cases, while 40.0% reported revascularizing all high-grade stenoses if any viable myocardium was present. Conclusion: This study highlights the variability in myocardial viability imaging practices across Europe, with differences in availability, preferred modalities, and clinical application. While CMR and TTE remain the dominant modalities, standardization of imaging protocols and further research are needed to optimize viability assessment and its impact on revascularization decisions.