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The hibernating myocardium: current concepts, diagnostic dilemmas, and clinical challenges in the post-STICH era
Benoy Nalin Shah1, Rajdeep Singh Khattar, Roxy Senior
1Department of Cardiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
European Heart Journal
|February 20, 2013
Summary
Revascularization may not improve survival in ischemic heart failure with hibernating myocardium, challenging current practices. Viability testing
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Imaging
Background:
- Retrospective evidence suggests revascularization benefits patients with hibernating myocardium.
- Contemporary practice emphasizes viability testing to guide revascularization decisions.
- The Surgical Treatment for Ischaemic Heart Failure (STICH) trial questioned these established practices.
Purpose of the Study:
- To review the pathophysiology of hibernating myocardium.
- To discuss non-invasive imaging modalities for detecting myocardial hibernation.
- To critically appraise prospective studies, including the STICH trial and its viability sub-study, on revascularization in ischemic heart failure.
Main Methods:
- Literature review focusing on pathophysiology and imaging techniques.
- Critical appraisal of prospective studies, particularly the STICH trial.
- Analysis of the STICH trial's viability sub-study.
Main Results:
- The STICH trial did not demonstrate a mortality benefit from revascularization or viability testing.
- Evidence supporting revascularization in ischemic heart failure remains debated post-STICH.
- The role of viability testing in clinical decision-making requires re-evaluation.
Conclusions:
- The STICH trial's findings necessitate a re-evaluation of revascularization strategies in ischemic heart failure.
- Further research, potentially through an 'ideal trial,' is needed to clarify the benefits of revascularization.
- Clinical practice guidelines for viability testing should be reassessed in light of recent evidence.
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