The detection of myocardial viability and its clinical implications.
The mortality, morbidity and economic burden imposed by congestive heart failure are considerable. Despite a prevalence and prognosis comparable to the more commonly encountered cancers like breast and lung cancer, there has been relatively less emphasis in the western world on the screening, diagnosis and treatment of heart failure, at least until recently. This may be partly attributed to the fact that the complex pathophysiology of heart failure was ill understood and the heterogeneity of the syndrome not recognised, so that even among specialist cardiologists it was considered pretty much an irreversible condition amenable only to palliative therapy. However, our understanding of heart failure has grown significantly in the past decade. From the early days when all dysfunctional myocardium was considered necrosed, and revascularisation often dismissed on this basis, we have now progressed to the understanding that dysfunctional myocardium is a heterogeneous entity comprising necrotic, stunned, hibernating and myopathic myocardium, and that the therapeutic objectives in each of these categories is specific and should be addressed individually. In this article we briefly review the pathophysiology, and diagnostic and therapeutic implications of reversible ischaemic left ventricular dysfunction.
Soman
Prem
P
Department of Internal Medicine, Lehigh Valley Hospital, Penn State University, Allentown, PA, USA.
Naidoo
Vahini
V
Lahiri
Avijit
A
D025401:Echocardiography, Stress; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D017682:Myocardial Stunning / Q000175:diagnosis / Q000503:physiopathology*; D013794:Thallium Radioisotopes; D014055:Tomography, Emission-Computed; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000503:physiopathology*
D013794:Thallium Radioisotopes