Nealy Zachariah, Wang Shuo, Patel Amit R
Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA.
Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA.
Prog Cardiovasc Dis. 2025 Jan-Feb;88:113-125. doi: 10.1016/j.pcad.2024.12.008. Epub 2025 Jan 7.
Myocardial viability assessment is used to determine if chronically dysfunctional myocardium may benefit from coronary revascularization. Cardiac magnetic resonance with late gadolinium enhancement is the current gold standard for visualizing myocardial scar and provides valuable insight into myocardial viability. Viability assessments can also be made with Cardiac Positron Emission Tomography, Echocardiography, Single Photon Emission Tomography, and Cardiac Computed Tomography with each having advantages and disadvantages. Despite the classical interpretation that viability predicts segmental functional improvement, more recent studies have found that revascularization of viable myocardium has conflicting roles in predicting benefits for patients, especially as it relates to major adverse cardiovascular events, development of heart failure symptoms, and all-cause mortality. This review covers these conflicts along with an in-depth review of the pathophysiologic processes that are fundamental to myocardial viability and the various methods used for determining viability.
心肌活力评估用于确定长期功能失调的心肌是否能从冠状动脉血运重建中获益。延迟钆增强心脏磁共振成像目前是可视化心肌瘢痕的金标准，并能为心肌活力提供有价值的见解。心肌活力评估也可通过心脏正电子发射断层扫描、超声心动图、单光子发射断层扫描和心脏计算机断层扫描进行，每种方法都有其优缺点。尽管传统观点认为心肌活力可预测节段性功能改善，但最近的研究发现，存活心肌的血运重建在预测患者获益方面存在矛盾作用，尤其是在与主要不良心血管事件、心力衰竭症状的发展和全因死亡率相关方面。本综述涵盖了这些矛盾之处，并深入回顾了心肌活力的基本病理生理过程以及用于确定心肌活力的各种方法。
