Myocardial Viability: From Proof of Concept to Clinical Practice.
Ischaemic left ventricular (LV) dysfunction can arise from myocardial stunning, hibernation, or necrosis. Imaging modalities have become front-line methods in the assessment of viable myocardial tissue, with the aim to stratify patients into optimal treatment pathways. Initial studies, although favorable, lacked sufficient power and sample size to provide conclusive outcomes of viability assessment. Recent trials, including the STICH and HEART studies, have failed to confer prognostic benefits of revascularisation therapy over standard medical management in ischaemic cardiomyopathy. In lieu of these recent findings, assessment of myocardial viability therefore should not be the sole factor for therapy choice. Optimization of medical therapy is paramount, and physicians should feel comfortable in deferring coronary revascularisation in patients with coronary artery disease with reduced LV systolic function. Newer trials are currently underway and will hopefully provide a more complete understanding of the pathos and management of ischaemic cardiomyopathy.
Department of Cardiology, Blacktown Hospital, Blacktown Road, Blacktown NSW 2148, Australia.
Aditya
0000-0002-6357-4808
A
Bhat
Department of Cardiology, Blacktown Hospital, Blacktown Road, Blacktown NSW 2148, Australia.
Gary C H
0000-0001-6430-2743
GC
Gan
Department of Cardiology, Blacktown Hospital, Blacktown Road, Blacktown NSW 2148, Australia; Western Sydney University, Richmond, NSW, Australia.
Timothy C
TC
Tan
Department of Cardiology, Blacktown Hospital, Blacktown Road, Blacktown NSW 2148, Australia.
Chijen
C
Hsu
Department of Cardiology, Blacktown Hospital, Blacktown Road, Blacktown NSW 2148, Australia; Western Sydney University, Richmond, NSW, Australia.
Alan Robert
AR
Denniss