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Role of revascularization to improve left ventricular function

Harsh C Patel1, Stephen G Ellis1

  • 1Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.

Heart Failure Clinics
|April 4, 2015
PubMed

Insights

Coronary revascularization for ischemic cardiomyopathy is debated, particularly without symptoms. While observational data suggest benefits for viable myocardium, recent trials show mixed results, leaving clinical questions unanswered.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Interventional Cardiology

Background:

  • Coronary revascularization aims to improve left ventricular (LV) function and survival in ischemic cardiomyopathy.
  • The benefit is debated, especially in patients without angina or ischemia.
  • Observational studies suggest positive outcomes for viable myocardium, but recent randomized trials present conflicting evidence.

Purpose of the Study:

  • To evaluate the role and outcomes of coronary revascularization in patients with ischemic cardiomyopathy.
  • To address the persistent clinical equipoise regarding revascularization in specific patient subgroups.

Main Methods:

  • Review of observational evidence and randomized trials on coronary revascularization for ischemic cardiomyopathy.
  • Analysis of studies focusing on left ventricular function, mortality, and viability testing.

Main Results:

  • Observational data indicate potential improvements in mortality and LV function after revascularization in patients with viable myocardium.
  • Recent randomized trials question the value of viability testing and revascularization for improving outcomes.
  • Methodological limitations in recent trials contribute to ongoing debate.

Conclusions:

  • The efficacy of coronary revascularization in ischemic cardiomyopathy, particularly in asymptomatic patients or those with viable myocardium, remains controversial.
  • Clinical equipoise persists due to conflicting evidence and study limitations.
  • Further research may be needed to clarify the role of revascularization in specific patient populations.

Keywords:
Coronary artery bypass graftingIschemic cardiomyopathyLV functionPercutaneous coronary interventionRevascularizationViability

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