The Use of Contrast-Enhanced Magnetic Resonance Imaging to Identify Reversible Myocardial Dysfunction

Before coronary revascularization, the key clinical question is: which stunned or hibernating myocardium will recover function if blood flow is restored? This study established contrast-enhanced MRI as a pre-procedural tool for answering that question.

In 50 patients scheduled for revascularization, the extent of gadolinium hyperenhancement on MRI — a marker of irreversible myocyte injury — predicted whether regional wall motion would improve post-procedure. As the transmural extent of scar increased, the likelihood of functional recovery fell in a graded, continuous fashion. The relationship was mechanistically coherent: dead tissue cannot contract, regardless of how much blood flows through it.

The clinical application is direct. Contrast-enhanced MRI can spare patients the risk and cost of revascularization in segments with transmural scar while identifying those with viable myocardium who will benefit. This study provided the early evidence base for viability-guided revascularization decisions, a practice now standard in pre-operative assessment.

We rate the evidence strong. A well-designed proof-of-concept study that established contrast-enhanced MRI viability assessment as a clinically useful tool — meaningful despite the small sample, which subsequent larger studies confirmed.