Department of Cardiology, Westchester Medical Center, 100 Woods Rd, Valhalla, NY, USA.
Department of Medicine, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY, USA.
Curr Cardiol Rep. 2023 Nov;25(11):1513-1521. doi: 10.1007/s11886-023-01977-5. Epub 2023 Oct 24.
We aim to reevaluate how the assessment of myocardial viability can guide optimal treatment strategies for patients with ischemic cardiomyopathy (ICM) based on a more contemporary understanding of the mechanism of benefit of revascularization.
The assessment of viability in left ventricular (LV) segments with diminished contraction has been proposed as key to predict the benefit of revascularization and, therefore, as a requisite for the selection of patients to undergo this form of treatment. However, data from prospective trials have diverged from earlier retrospective studies. Traditional binary viability assessment may oversimplify ICM's complexity and the nuances of revascularization benefits. A conceptual shift from the traditional paradigm centered on the assessment of viability as a dichotomous variable to a more comprehensive approach encompassing a thorough understanding of ICM's complex pathophysiology and the salutary effect of revascularization in the prevention of myocardial infarction and ventricular arrhythmias is required.
我们旨在根据对血运重建获益机制的更现代的理解，重新评估评估存活心肌对缺血性心肌病（ICM）患者最佳治疗策略的指导作用。
左心室（LV）收缩功能减弱节段的存活心肌评估已被提出作为预测血运重建获益的关键因素，因此，也是选择接受这种治疗形式的患者的必要条件。然而，前瞻性试验的数据与早期的回顾性研究结果存在差异。传统的二元存活心肌评估可能过于简化了 ICM 的复杂性和血运重建获益的细微差别。需要从以评估存活心肌作为二分类变量为中心的传统模式转变为一种更全面的方法，全面了解 ICM 的复杂病理生理学以及血运重建在预防心肌梗死和室性心律失常方面的有益作用。
