Revascularization in Ischemic Left Ventricular Dysfunction: A Pathophysiology-Guided, Evidence-Based Approach.

Area of Science:

• Cardiology
• Heart Failure Research
• Interventional Cardiology

Background:

• Ischemic left ventricular dysfunction (iLVD) is a leading cause of heart failure with reduced ejection fraction.
• iLVD is linked to higher mortality rates compared to nonischemic cardiomyopathy.
• Historically, coronary revascularization was standard for iLVD, but recent trials challenge this practice.

Purpose of the Study:

• To review the pathophysiology of iLVD.
• To analyze randomized trial evidence regarding coronary revascularization in iLVD.
• To define patient selection criteria for coronary artery bypass grafting and percutaneous coronary intervention (PCI) in iLVD.

Main Methods:

• Comprehensive literature review of pathophysiology and clinical trials.
• Analysis of randomized evidence for coronary revascularization strategies.
• Development of a practical guide for PCI in iLVD patients.

Main Results:

• The review synthesizes current understanding of iLVD pathophysiology.
• Evidence from recent randomized trials is critically examined.
• Guidelines are provided for selecting iLVD patients who benefit from revascularization.

Conclusions:

• Coronary revascularization decisions for iLVD require careful patient selection.
• Percutaneous coronary intervention (PCI) planning and execution are detailed.
• Shared decision-making and complete revascularization are emphasized, with future mechanical circulatory support trials noted.