The last three decades have witnessed an unprecedented improvement in the outcome of patients with acute coronary syndromes. The widespread use of thrombolytic therapy and percutaneous coronary interventions in association with increasingly potent anti-thrombotic agents, has contributed to reduce significantly mortality and morbidity in these patients. Although overall survival has improved, a downside of this success has been the greater number of patients with residual left ventricular (LV) dysfunction undergoing progressive LV remodeling and congestive heart failure (CHF). This problem is also compounded by the rising age of our population and the higher prevalence of co-morbidities such as diabetes mellitus which confer an increased risk of coronary artery disease (CAD) and CHF. Patients with CAD represent by far the most numerous cohort amongst those with CHF and their treatment remains a partial success 1. Typically, these patients have multivessel disease, increased LV volumes and variable degrees of regional and/or global systolic dysfunction, although recently more cases of isolated diastolic dysfunction have been reported 2-4. In these patients coronary revascularization may lead to symptomatic and prognostic improvement and these clinical benefits are accompanied by evidence of reverse LV remodeling. In this context, the concept of myocardial viability was developed and a number of different techniques have been used to demonstrate the presence of viable tissue before coronary revascularization. The aim of this review article is to summarize our current understanding of the concept of myocardial viability and its clinical implications in patients with CAD and chronic LV dysfunction. Throughout this review we use the term viability to describe dysfunctional myocardium subtended by diseased coronary arteries with limited or absent scarring which has, therefore, the potential for functional recovery. Viability is a prospective definition, but it does not imply evidence of functional recovery following interventions. The term hibernation, which is often used as synonymous of tissue viability, is a retrospective definition based on evidence of functional recovery following interventions.
Stunning, hibernation and assessment of viability
CAMICI , PAOLO;
2008-01-01
Abstract
The last three decades have witnessed an unprecedented improvement in the outcome of patients with acute coronary syndromes. The widespread use of thrombolytic therapy and percutaneous coronary interventions in association with increasingly potent anti-thrombotic agents, has contributed to reduce significantly mortality and morbidity in these patients. Although overall survival has improved, a downside of this success has been the greater number of patients with residual left ventricular (LV) dysfunction undergoing progressive LV remodeling and congestive heart failure (CHF). This problem is also compounded by the rising age of our population and the higher prevalence of co-morbidities such as diabetes mellitus which confer an increased risk of coronary artery disease (CAD) and CHF. Patients with CAD represent by far the most numerous cohort amongst those with CHF and their treatment remains a partial success 1. Typically, these patients have multivessel disease, increased LV volumes and variable degrees of regional and/or global systolic dysfunction, although recently more cases of isolated diastolic dysfunction have been reported 2-4. In these patients coronary revascularization may lead to symptomatic and prognostic improvement and these clinical benefits are accompanied by evidence of reverse LV remodeling. In this context, the concept of myocardial viability was developed and a number of different techniques have been used to demonstrate the presence of viable tissue before coronary revascularization. The aim of this review article is to summarize our current understanding of the concept of myocardial viability and its clinical implications in patients with CAD and chronic LV dysfunction. Throughout this review we use the term viability to describe dysfunctional myocardium subtended by diseased coronary arteries with limited or absent scarring which has, therefore, the potential for functional recovery. Viability is a prospective definition, but it does not imply evidence of functional recovery following interventions. The term hibernation, which is often used as synonymous of tissue viability, is a retrospective definition based on evidence of functional recovery following interventions.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
