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The benefits of revascularization in chronic heart failure

Sothinathan Gurunathan1, Asrar Ahmed, Roxy Senior

  • 1Department of Cardiology, Northwick Park Hospital, Harrow, UK.

Current Heart Failure Reports
|December 16, 2014
PubMed

Insights

Assessing myocardial viability is key for managing ischemic cardiomyopathy (ICM). While revascularization benefits hibernating myocardium, recent trials suggest optimal medical therapy may be non-inferior.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Heart Failure Management

Background:

  • Coronary artery disease (CAD) mortality reduction has increased heart failure with reduced left ventricular function, known as ischemic cardiomyopathy (ICM).
  • Myocardial viability assessment is crucial as ischemic left ventricular (LV) dysfunction can be reversible with revascularization if viable myocardium is present.

Purpose of the Study:

  • To review noninvasive imaging modalities for assessing myocardial viability.
  • To evaluate the impact of myocardial viability on revascularization outcomes in ICM.
  • To critically appraise the STICH trial and propose an algorithm for pre-revascularization viability testing in ICM patients with LV dysfunction.

Main Methods:

  • Review of observational analyses and the Surgical Treatment for Ischaemic Heart Failure (STICH) trial.
  • Discussion of noninvasive imaging techniques for myocardial viability assessment.
  • Critical appraisal of existing evidence and trial data.

Main Results:

  • Observational studies historically supported revascularization for hibernating myocardium to improve survival.
  • The STICH trial indicated non-inferiority of optimal medical therapy (OMT) compared to revascularization plus OMT.
  • Myocardial viability significantly influences the decision-making process for revascularization in ICM.

Conclusions:

  • Myocardial viability assessment remains central to guiding revascularization decisions in ischemic cardiomyopathy.
  • The STICH trial necessitates a re-evaluation of the role of revascularization versus OMT.
  • An algorithm incorporating viability testing prior to revascularization is proposed for patients with ICM and significant LV dysfunction.

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