Department of Cardiovascular Medicine, Flinders Medical Centre, Australia.
Prog Cardiovasc Dis. 2011 Nov-Dec;54(3):204-14. doi: 10.1016/j.pcad.2011.06.004.
Assessment of myocardial viability is of clinical and scientific significance. Traditionally, the detection of myocardial viability (either stunning or hibernation) has been used in aiding diagnosis before revascularization, especially in high-risk patients. There is a considerable body of observational evidence showing substantial improvement after revascularization in patients with significant left ventricular dysfunction and myocardial viability. Recent randomized evidence has questioned the benefit of viability testing but must be interpreted with caution. Dobutamine stress echocardiography, nuclear imaging, and cardiovascular magnetic resonance are the mainstays of viability testing and provide information on contractile function, cellular metabolism, and myocardial fibrosis, respectively. Larger, multicenter trials with outcome data are needed to define the nature of viability testing and, particularly, cardiovascular magnetic resonance in moderate-to-severe ischemic cardiomyopathy.
评估心肌活力具有临床和科学意义。传统上，在血运重建之前，检测心肌活力（顿抑或冬眠）有助于诊断，尤其是对高危患者。大量观察性证据表明，在左心室功能严重障碍和心肌活力的患者中，血运重建后有显著改善。最近的随机证据对存活心肌检测的益处提出了质疑，但必须谨慎解读。多巴酚丁胺负荷超声心动图、核成像和心血管磁共振是存活心肌检测的主要方法，分别提供收缩功能、细胞代谢和心肌纤维化的信息。需要更大规模、多中心的临床试验来明确存活心肌检测的性质，特别是在中重度缺血性心肌病中应用心血管磁共振。
