Management of ischemic cardiomyopathy is challenging, especially when treatment benefits do not clearly exceed the estimated risk of procedures. Myocardial viability assessment provides additional data in this setting to anticipate potential functional recovery and possibly prognostic improvement following revascularization. This evidence comes from the positive signals received from posthoc analyses of some clinical trials. There are multiple clinically available modalities to evaluate myocardial viability among which more sensitive ones such as cardiac magnetic resonance and PET are more preferrable. Yet, there are emerging tools that may further escalate the utility of these modalities.