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The Evolving Paradigm of Revascularization in Ischemic Cardiomyopathy: from Recovery of Systolic Function to Protection Against Future Ischemic Events

  • Interventional Cardiology (SR Bailey and T Helmy, Section Editors)
  • Published:
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Abstract

Purpose of Review

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.

Recent Findings

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.

Summary

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.

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Abbreviations

AMI:

Acute myocardial infarction

CABG:

Coronary artery bypass grafting

CAD:

Coronary artery disease

EF:

Ejection fraction

HF:

Heart failure

ICM:

Ischemic cardiomyopathy

IHD:

Ischemic heart disease

LV:

Left ventricular

LVEF:

Left ventricular ejection fraction

MI:

Myocardial infarction

cMRI:

Cardiac magnetic resonance imaging

OMT:

Optimal medical therapy

PCI:

Percutaneous coronary intervention

PET:

Positron emission tomography

RCTs:

Randomized control trials

SPECT:

Single-photon emission computed tomography

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Authors and Affiliations

  1. Department of Cardiology, Westchester Medical Center, 100 Woods Rd, Valhalla, NY, USA

    Ameesh Isath & Julio A. Panza

  2. Department of Medicine, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY, USA

    Julio A. Panza

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Isath, A., Panza, J.A. The Evolving Paradigm of Revascularization in Ischemic Cardiomyopathy: from Recovery of Systolic Function to Protection Against Future Ischemic Events. Curr Cardiol Rep 25, 1513–1521 (2023). https://doi.org/10.1007/s11886-023-01977-5

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