Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Am J Med. 2010 Nov;123(11):978-86. doi: 10.1016/j.amjmed.2010.03.025.
Patients with chronic ischemic left ventricular dysfunction may have a substantial amount of viable, hibernating myocardium, which is a state of chronic contractile dysfunction with reduced blood flow at rest. Coronary revascularization in these patients may result in improvement of left ventricular function; in the absence of viability, left ventricular function will not improve postrevascularization. Various noninvasive imaging techniques are available for detection of viable myocardium, including magnetic resonance imaging, dobutamine stress echocardiography, and nuclear imaging with single photon emission computed tomography or positron emission tomography. Because these techniques probe different characteristics of viable myocardium, the sensitivities and specificities of the techniques are not precisely identical; in general, dobutamine stress echocardiography has the highest specificity, whereas the nuclear techniques have the highest sensitivity. The presence of myocardial viability also is related to prognosis: patients with viable myocardium who undergo revascularization have a good prognosis, whereas patients with viable myocardium who are treated medically have poor outcome. Accordingly, assessment of viability is important in the therapeutic decision-making process of patients with chronic ischemic left ventricular dysfunction.
患有慢性缺血性左心室功能障碍的患者可能存在大量存活的、冬眠的心肌，这是一种在休息时血流减少的慢性收缩功能障碍状态。这些患者的冠状动脉血运重建可能导致左心室功能的改善；如果没有存活的心肌，血运重建后左心室功能不会改善。有多种非侵入性成像技术可用于检测存活的心肌，包括磁共振成像、多巴酚丁胺负荷超声心动图以及单光子发射计算机断层扫描或正电子发射断层扫描的核成像。由于这些技术探测存活心肌的不同特征，因此技术的敏感性和特异性并不完全相同；一般来说，多巴酚丁胺负荷超声心动图的特异性最高，而核技术的敏感性最高。存活心肌的存在也与预后有关：接受血运重建的存活心肌患者预后良好，而接受药物治疗的存活心肌患者预后不良。因此，评估存活心肌对于慢性缺血性左心室功能障碍患者的治疗决策过程很重要。
