Bolognese Leonardo, Reccia Matteo Rocco
Cardiovascular Department, Azienda Ospedaliera Toscana Sudest.
Eur Heart J Suppl. 2024 Apr 17;26(Suppl 1):i15-i18. doi: 10.1093/eurheartjsupp/suae005. eCollection 2024 Apr.
The concept of myocardial viability is usually referred to areas of the myocardium, which show contractile dysfunction at rest and in which contractility is expected to improve after revascularization. The traditional paradigm states that an improvement in function after revascularization leads to improved health outcomes and that assessment of myocardial viability in patients with ischaemic left ventricular dysfunction (ILVD) is a prerequisite for clinical decisions regarding treatment. A range of retrospective observational studies supported this 'viability hypothesis'. However, data from prospective trials have diverged from earlier retrospective studies and challenge this hypothesis. Traditional binary viability assessment may oversimplify ILVD's complexity and the nuances of revascularization benefits. A conceptual shift from the traditional paradigm centred on the assessment of viability as a dichotomous variable to a more comprehensive approach encompassing a thorough understanding of ILVD's complex pathophysiology and the salutary effect of revascularization in the prevention of myocardial infarction and ventricular arrhythmias is required.
心肌存活的概念通常指心肌区域，这些区域在静息时表现出收缩功能障碍，并且预计在血运重建后收缩性会改善。传统观念认为，血运重建后功能的改善会带来更好的健康结局，并且对缺血性左心室功能障碍（ILVD）患者进行心肌存活评估是治疗临床决策的先决条件。一系列回顾性观察性研究支持了这一“存活假设”。然而，前瞻性试验的数据与早期回顾性研究有所不同，并对这一假设提出了挑战。传统的二元存活评估可能会过度简化ILVD的复杂性以及血运重建益处的细微差别。需要从以将存活评估作为二分变量为中心的传统模式，转变为一种更全面的方法，该方法要全面理解ILVD复杂的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。
