Why the study?
Ischemic heart disease is a common cause of heart failure in India, but most therapeutic data derive from observational and registry studies, underscoring the need to review revascularization and myocardial viability.
Does revascularization improve outcomes and LV function in patients with ischemic heart failure compared to medical therapy?
Does revascularization improve outcomes and LV function in patients with ischemic heart failure compared to medical therapy?
This review highlights that while observational data favor CABG over PCI and medical therapy for ischemic heart failure, there is a critical need for randomized controlled trials to guide revascularization strategies.
May support preferring CABG in ischemic HF per observational data; leaves open need for RCTs to guide revascularization.
Ischemic heart disease as a cause of heart failure is common in India, ranging from 48% to 71%. The pathoanatomic basis of LV dysfunction is not only due to infarcted myocardium, but also due to viable but dysfunctional myocardium (hibernating/stunned myocardium) and structural abnormalities (mitral regurgitation/ventricular septal defect aneurysm) consequent to obstructive coronary artery disease. Evaluation of dysfunctional but viable myocardium is a key determinant of recovery of LV function, and magnitude of recovery is proportional to the amount of dysfunctional viable myocardium which if more than 25% LV (4 segments out of 17 segments model) results in improvement in function and size (reverse remodeling). Most of the data regarding therapy come from observational, registry data showing better outcomes with coronary artery bypass graft than percutaneous coronary intervention and medical therapy. The need for more multicentric, randomized controlled trials regarding recovery of LV function by various therapies is more than ever now.
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Lakshman et al. (2020) studied this question.
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