This review explores whether assessing myocardial viability before coronary revascularization meaningfully impacts outcomes in patients with ischemic cardiomyopathy. By synthesizing evidence from studies employing imaging techniques such as CMR, PET, SPECT, and dobutamine stress echocardiography, we examined associations between viability status and improvements in cardiac function and survival. Our findings suggest that patients with viable myocardium tend to derive greater benefit from revascularization, particularly in terms of left ventricular recovery and reduced mortality. These results highlight the potential value of viability imaging in guiding treatment decisions and support its selective use in clinical practice.

The authors have declared no competing interest.

This study did not receive any funding

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study used ONLY openly available human data that were publicly accessible before the initiation of the study. All data were extracted from previously published studies available through PubMed and journal websites. The original data sources can be accessed at the following links: https://doi.org/10.1161/hc3501.096798 https://doi.org/10.1253/jcj.61.481 https://doi.org/10.1016/s0735-1097(00)00968-2 https://doi.org/10.1016/j.jtcvs.2011.04.040 https://doi.org/10.1161/01.cir.100.19.1992 https://doi.org/10.1016/s0735-1097(97)00061-2 https://doi.org/10.1016/s0735-1097(98)00324-6 https://doi.org/10.1186/1532-429x-12-56 https://doi.org/10.2967/jnumed.110.084954 https://pubmed.ncbi.nlm.nih.gov/10565777/ https://pubmed.ncbi.nlm.nih.gov/10945518/ https://pubmed.ncbi.nlm.nih.gov/9170439/ https://doi.org/10.1002/clc.4960261111 https://doi.org/10.1016/s0022-5223(03)00822-5 https://doi.org/10.1002/clc.24307 https://doi.org/10.1016/s0022-5223(98)70052-2 https://doi.org/10.1016/j.jacc.2011.09.073 https://doi.org/10.1016/j.jtcvs.2014.06.090 https://doi.org/10.1016/j.jtcvs.2008.11.040 https://doi.org/10.1016/s0022-5223(98)70357-5 https://doi.org/10.1016/j.jacc.2021.07.004 https://doi.org/10.1253/circrep.CR-19-0126 No datasets required application, registration, or request for access. All sources were publicly available and accessed via standard indexing services (e.g., PubMed) before the study was initiated.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

All data produced in the present work are contained within the manuscript and its supplementary materials. The data were extracted from publicly available published studies, all of which are cited and referenced.