To Revascularise or Not To Revascularise, That Is the Question: the Diagnostic and Management Conundrum of Ischaemic Cardiomyopathy.
Ischaemic cardiomyopathy is an important cardiovascular condition that has differing pathophysiological substrates and clinical manifestations. Contemporary management involves the administration of heart failure pharmacotherapy and device therapy where indicated, which has good prognostic data to support it. Whilst the role of revascularisation is clear in those patients presenting with an acute coronary syndrome or angina, the role in those patients presenting either incidentally, with predominant heart failure symptoms, or in those presenting with acute heart failure with an associated elevated troponin is less well defined and lacks randomised outcome data to support its adoption. The aim of this review is therefore to discuss the challenges in the diagnosis of ischaemic cardiomyopathy with a review of the existing imaging modalities that can facilitate, and to revisit the variety of clinical presentations that can occur, with particular emphasis on the contemporary role of revascularisation in these cohorts of patients.
British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, Cardiovascular Division, St Thomas' Hospital Campus, Kings College London, London, UK.
Natalia
N
Briceno
British Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, Cardiovascular Division, St Thomas' Hospital Campus, Kings College London, London, UK. divaka.perera@kcl.ac.uk.
Divaka
D
Perera
D017023:Coronary Angiography; D006801:Humans; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000379:methods*; D017410:Practice Guidelines as Topic; D057285:Precision Medicine; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000628:therapy*
Ischaemia; Ischaemic cardiomyopathy; Revascularisation; Viability