HYBRID EVENT: You can participate in person at Paris, France or Virtually from your home or work.

3rd Edition of Cardiology World Conference

September 14-15, 2022 | Hybrid Event

September 14 -15, 2022 | Paris, France
CWC 2021

Viable myocardium: Clinical sufficiency and prognostic implication

Natallia Maroz Vadalazhskaya, Speaker at Speaker for CWC Conference- Natallia Maroz-Vadalazhskaya
Belarusian State Medical University, Belarus
Title : Viable myocardium: Clinical sufficiency and prognostic implication


The estimation of prognosis of the different cardiovascular diseases is still very challenging because of the multifactorial impact in the condition of therapeutic or surgical treatment, their subsequent or simultaneous affect. Ischemic heart disease, as a chronic progressive disease, is complicated by transient nonfatal or fatal damage of myocardium in the majority of cases. Loss of the number of myofibrils leads to loss of heart contractility with the depression of local systolic and diastolic deformation and in patients with transmural or large scar area – loss of local systolic function. Described histologic changes in the area of post ischemic myocardial scar can be visualized by diagnostic ultrasound, cardiac single-photon emission computer tomography (SPECT), magnetic resonance (CMR), cardiac computer tomography (CardiacCT), positron-emission tomography (PET). In this case prognosis is based on the function of damaged myocardium in the rest conditions, not mentioning any provoking factors, which are common in the real life and resulted hemodynamic storm, increasing myocardial wall stress, decreasing of pump function dramatically, worsening follow up and survival.

A study of contractility reserve is advised to be more appropriate diagnostic method in patients with ischemic depressed myocardium to judge a global response to physical or psychoemotional load, and build short and long term prognosis, following the steps of a treatment algorithm. Diagnostic approach to measure myocardial viability using cardiac ultrasound is acceptable in the majority of patients with favorable acoustic window. A diagnosed myocardial viability at low dose dobutamine or low dose dipyridamole echo gives opportunity to perform a left ventricle reconstruction with an optimization of left ventricle end-diastolic volume, following Frank-Starling law. Poor acoustic window doesn’t give to estimate myocardial contractility. In these patients other noninvasive techniques (stress-SPECT, stress-CMR, stress-CardiacCT, stressPET) are used with a modelling of the stress condition by dipyridamole.

A prognostic significance of viable myocardium in patients with ischemic heart disease was assessed in multicenter studies. Nevertheless, an existed criticism of the results of STICH and ISCHEMIA triggered subanalysis in frame of these studies and shows we still need more proves to perform an estimation of myocardial viability routinely using high quality equipment and clinical experience of high grade cardiologists and radiologists.


Dr Maroz-Vadalazhskaya studied Medicine at the Belarusian State Medical University (BSMU), Minsk, Republic of Belarus as MD in 1994. She then worked at Scientific-Practical Center of Cardiology in Minsk, Republic of Belarus. She received her PhD degree in 1998 at the same institution. In 2012-2014 she worked as a head of Minsk City Cardiologic Centre, 2015-2017 –chief of biomedical laboratory of Scientific-Practical Center of sports. In 2017 she obtained the position of an Associate Professor at the BSMU. She has published more than 100 research articles in Russian and English, presented her work during multiple European and International congresses.