Patient-specific registration of segmental jeopardy and viability is a feasible strategy to identify patients with ischemic cardiomyopathy (ICM) who benefit from early revascularization, according to a recent study published in JACC: Cardiovascular Imaging.

Jacob Abdaem, MD, et al., included 941 patients with ICM (mean age 65 years; 81% male) who underwent cardiac magnetic resonance (CMR) and invasive coronary angiography between 2015 and 2022. The authors estimated segmental perfusion jeopardy from patient-specific vascular trees, and by taking segmental viability scores into account, determined jeopardized but viable segments.

Overall, 193 patients underwent early revascularization, and there were 168 deaths over a median follow-up period of 4.8 years. Patients with three or more jeopardized but viable segments exhibited significantly lower mortality after early revascularization (propensity score-adjusted hazard ratio: 0.55; p=0.015).

"Consistent with previous studies, viability alone and global measures of [coronary artery disease] burden alone did not modify the relationship between revascularization and mortality," write the authors. "Accordingly, the segmental registration of patient-specific coronary anatomy and myocardial viability appears to be the critical factor for estimating revascularization benefit in patients with ICM."

In an accompanying editorial comment, Robert S. Zhang, MD, BA, FACC, and Jonathan W. Weinsaft, MD, FACC, note that "this paper provides valuable insights and demonstrates an integrated anatomic/functional imaging approach that is both feasible and meaningful…the approach used to determine jeopardized myocardium leveraged primary CMR and invasive angiographic approaches widely available in routine clinical practice enhancing generalizability."