Ischemic cardiomyopathy (ICM) is an important cause of heart failure with reduced ejection fraction. Despite the improvement of treatment methods, it still has a high mortality. Coronary revascularization is an important treatment for ICM patients, due to the fact that ICM patients are elderly, have multiple diseases and severe coronary artery lesions, the risk of revascularization is relatively high. Currently, there is still controversy over whether and how to revascularization in ICM patients. Myocardial viability has predictive value for the prognosis of ICM patients and provides reference for selecting treatment strategies, but its guiding value for revascularization in ICM patients still needs further verification. This article provides a review of the current treatment of ICM patients, commonly used methods for myocardial viability assessment, and the clinical application of myocardial viability to guide revascularization, so as to provide reference for clinical work.

缺血性心肌病（ICM）是引起射血分数减低性心力衰竭的重要病因，尽管治疗手段在不断提高，但是仍具有较高的死亡率。血运重建是ICM患者重要的治疗方法，由于ICM患者多为老年人、合并多种基础疾病且冠状动脉病变重，血运重建的风险较高，目前对于ICM患者是否血运重建及血运重建的方式仍存在争议。心肌活性对ICM患者的预后具有预测价值，并为选择治疗策略提供参考，但是其对ICM患者血运重建的指导价值仍有待进一步验证。现对ICM患者目前治疗现状、心肌活性评估的常用方法以及临床应用心肌活性评估指导血运重建的现状进行综述，为临床ICM的治疗提供参考。