Key result
Functional methods such as stress echocardiography and cardiac magnetic resonance appear more specific, but less sensitive, than nuclear modalities for detecting hibernating myocardium.
Why the study?
Does revascularization provide a survival benefit over medical therapy in patients with ischemic left ventricular systolic dysfunction and known viable myocardium?
Does revascularization provide a survival benefit over medical therapy in patients with ischemic left ventricular systolic dysfunction and known viable myocardium?
This review highlights that identifying hibernating myocardium using various imaging modalities can help select patients with ischemic left ventricular systolic dysfunction who may derive a survival benefit from revascularization.
Supports cautious viability testing interpretation; leaves open optimal modality for predicting revascularization benefit.
Ischemic left ventricular systolic dysfunction may result from myocardial necrosis or from hypocontractile areas of viable myocardium. In some cases, recovery of contractility may occur on revascularization--this reversibly dysfunctional tissue is commonly referred to as hibernating myocardium. Observational data suggest that revascularization of patients with ischemic left ventricular systolic dysfunction and known viable myocardium provides a survival benefit over medical therapy. Identification of viable, dysfunctional myocardium may be especially worthwhile in deciding which patients with ischemic left ventricular systolic dysfunction will benefit from revascularization procedures. Randomized, prospective trials evaluating this are currently ongoing. This review will provide an overview of the complex pathophysiology of viable, dysfunctional myocardium, and will discuss outcomes after revascularization. Of the techniques used to determine the presence of hibernating myocardium, functional methods such as stress echocardiography and cardiac magnetic resonance appear more specific, but less sensitive, than the nuclear modalities, which assess perfusion and metabolic activity. Currently, the availability of all methods is variable.
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Bhatia et al. (2005) conducted a review in Ischemic left ventricular systolic dysfunction and hibernating myocardium. Viability testing and revascularization vs. Medical therapy was evaluated. Functional methods such as stress echocardiography and cardiac magnetic resonance appear more specific, but less sensitive, than nuclear modalities for detecting hibernating myocardium.
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