Review Article

In patients with relatively preserved left ventricular function (left ventricular ejection fraction >35%) and symptoms of angina pectoris, interfering with the daily life-style of the patient, coronary revascularization may be indicated without the need of viability studies. It is in the subgroup of patients with poor left ventricular function (ƒ35%) and symptoms of congestive heart failure (ischaemic cardiomyopathy) that viability studies are indicated. The therapeutic options in these patients include medical therapy, revascularization or heart transplantation. The latter option is still restricted due to the relative shortage of donor hearts. Therefore the choice of therapy for the majority of these patients will be either medical therapy or revascularization, particularly since revascularization procedures in these patients are associated with an increased risk of periprocedural complications [12] . But the improvement of both left ventricular ejection fraction [13] and functional class [14] in patients with dysfunctional but viable tissue undergoing revascularization justifies revascularization procedures in these patients.