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Reversible left ventricular dysfunction: does it affect clinical practice and does it matter?
S R Redwood1, R Ferrari, M S Marber
1Department of Cardiology, St Thomas' Hospital, London, UK.
Insights
Identifying hibernating or stunned myocardium in patients with coronary artery disease is crucial. Revascularization can improve heart function and potentially prognosis in these individuals.
Area of Science:
- Cardiology
- Cardiac Imaging
- Heart Failure
Background:
- Coronary artery disease (CAD) frequently leads to impaired left ventricular (LV) function.
- A significant portion of patients with LV dysfunction may have viable but dysfunctional myocardium (hibernating or stunned).
- Identifying this reversible dysfunction is key for therapeutic decisions.
Purpose of the Study:
- To highlight the importance of identifying hibernating or stunned myocardium in patients with CAD.
- To discuss the potential benefits of revascularization in improving cardiac function and prognosis.
- To review the diagnostic modalities for detecting reversible LV dysfunction.
Main Methods:
- Review of existing evidence on myocardial hibernation/stunning in CAD.
- Discussion of the impact of revascularization on LV function and patient outcomes.
- Evaluation of diagnostic tools for assessing myocardial viability.
Main Results:
- Revascularization in patients with hibernating or stunned myocardium is associated with improved LV function.
- Evidence suggests that revascularization may improve the prognosis of these patients.
- Specific imaging techniques are effective in identifying reversible LV dysfunction.
Conclusions:
- Identifying hibernating or stunned myocardium is clinically significant in patients with CAD and LV dysfunction.
- Revascularization offers a therapeutic strategy to improve cardiac function and potentially survival.
- Dobutamine echocardiography, thallium scanning, and PET scanning are valuable diagnostic tools.
Abstract:
There is substantial evidence that many patients with impaired left ventricular function secondary to coronary artery disease may have hibernating or stunned myocardium. The identification of these patients is important, as revascularisation is associated with an improvement in function, and there is some evidence that revascularisation of these patients will actually improve prognosis. The most useful investigations for the identification of reversible left ventricular dysfunction are dobutamine echocardiography, thallium scanning and, although not available in many centres, PET scanning.