Myocardial Viability And Survival In Ischemic Left Ventricular Dysfunction Pdf
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- NEJM Journal Watch
- NEJM Journal Watch
- 2005, Number 2
- Myocardial viability and survival in ischemic left ventricular dysfunction
NEJM Journal Watch
The aim of revascularizing the infarct-related coronary artery IRCA is to restore interrupted or reduced blood flow, as well as to achieve some degree of functional recovery, avoid ventricular remodeling, and improve prognosis. From the clinical perspective, viable myocardium can be defined as myocardium in which contractile function is expected to improve, or in which remodeling can be avoided, once blood flow has been restored. Simple diagnostic methods such as the electrocardiogram, resting echocardiography, and ventriculography are available to detect myocardial necrosis. Assessing myocardial viability poses two difficulties. In the first place, viability is not a dichotomous concept, as there are degrees of viability ranging from complete absence to total normality. In the second place, the lack of a standard reference model means that precise assessment of myocardial viability is not possible at present, so that results obtained with current assessment methods may be open to discussion.
Chronic heart failure is a major public-health problem with a high prevalence, complex treatment, and high mortality. A careful and comprehensive analysis is needed to provide optimal and personalized therapy to heart failure patients. The main 4 non-invasive imaging techniques echocardiography, magnetic resonance imaging, multi-detector-computed tomography, and nuclear imaging provide information on cardiovascular anatomy and function, which form the basis of the assessment of the pathophysiology underlying heart failure. This complete information will enable personalized treatment of the patient with ischemic heart failure. Chronic heart failure has become one of the clinically most important diseases of the heart. The prevalence is high; the treatment is complex, and the mortality is significant. Importantly, 5.
NEJM Journal Watch
Ischemic heart failure is a growing disease with high morbidity and mortality. Several studies suggest the benefit of viability imaging to assist revascularization decision, but there is controversy. Multiple imaging modalities can be used to accurately define hibernating myocardium; however, the best approach remains uncertain. This review will highlight current evidence and future directions of viability imaging assessment. Ischemic heart failure HF is the leading cause of HF and an epidemic disease worldwide with growing prevalence and high mortality rate. Accumulated evidence of the past years has suggested that individualized-target therapy with viability imaging assessment may improve outcome.
2005, Number 2
Metrics details. Percutaneous coronary interventions PCI in patients with ischemic systolic left ventricular dysfunction SLVD are routinely performed although their impact on prognosis remains unclear. Of note, PCI significantly reduced the symptom of angina from
Background: Myocardial viability assessment in revascularization of ischemic heart failure remains controversial. This study evaluated the prognostic utility of cardiac magnetic resonance CMR late gadolinium enhancement LGE in ischemic heart failure. Analyses were stratified by treatment.
Myocardial viability and survival in ischemic left ventricular dysfunction
Stunning and hibernation represent two different forms of tissue viability identifiable in acute coronary syndromes and chronic ischaemic cardiomyopathy, respectively. Functional recovery occurs spontaneously with myocardial stunning, while it generally follows revascularization in case of hibernating myocardium. Low-dose dobutamine stress echocardiography is an accurate modality for identifying myocardial stunning and provides important information on ventricular remodelling after both systemic thrombolysis and primary angioplasty. In patients with conservatively treated infarction, the prognostic significance of viability by dobutamine stress echocardiography correlates with residual pump function. Substantial contractile reserve is predictive of favourable outcome in patients with poor but not in those with preserved or slightly reduced left ventricular function. Non-invasive assessment of coronary flow reserve with transthoracic Doppler echocardiography of the left anterior descending coronary artery allows to distinguish between necrotic and stunned myocardium and predicts ventricular remodelling following primary angioplasty. Resting echocardiographic examination can provide information on hibernating myocardium.
Harlan M. N Engl J Med Aug In a year follow-up, myocardial viability does not predict benefit from revascularization or mortality. We cardiologists have long lived with the idea that the assessment of myocardial viability should inform decisions about revascularization, particularly in patients with ischemic cardiomyopathy, but some studies have questioned this reasonable assumption.
Key words:. Myocardial viability on echocardiography predicts long term survival after revascularization in patients with ischemic congestive heart failure. J Am Coll Cardiol ; Galatro K, Chaudhry F. Prognostic implications of myocardial contractil reserve in patients with ischemic cardiomyopathy. Echocardiography ; 17 1 : Prediction of global left ventricular function after bypass surgery in patients with severe left ventricular dysfunction.
B, Data were fit using linear regression. A, Inverse relationship between scar burden and change in regional systolic wall thickening after revascularization. C, Inverse relationship between scar burden within the thinned region and change in global left ventricular LV ejection fraction. A, Before revascularization, cine-CMR still frames in systole and diastole demonstrate akinesis and thinning of the anteroseptal, anterior, and apical walls. C, After revascularization, cine-CMR still frames demonstrate improvement in myocardial contractility along with reversal of thinning in the previously thinned region. End-diastolic wall thickness changed from 4.
Box , Doha, Qatar. Some patients with chronic ischemic left ventricular dysfunction have shown significant improvements of contractility with favorable long-term prognosis after revascularization. Several imaging techniques are available for the assessment of viable myocardium, based on the detection of preserved perfusion, preserved glucose metabolism, intact cell membrane and mitochondria, and presence of contractile reserve. Nuclear cardiology techniques, dobutamine echocardiography and positron emission tomography are used to assess myocardial viability. In recent years, new advances have improved methods of detecting myocardial viability. This paper summarizes the pathophysiology, methods, and impact of detection of myocardial viability, concentrating on recent advances in such methods.
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