Ischemic left ventricle systolic dysfunction: An evidence-based approach in diagnostic tools and therapeutics

Abstract

Summary Coronary artery disease (CAD) associated with left ventricular systolic dysfunction is a condition related to poor prognosis. There is a lack of robust evidence in many aspects related to this condition, from definition to treatment. Ischemic cardiomyopathy is a spectrum ranging from stunned myocardium associated with myocardial fibrosis to hibernating myocardium and repetitive episodes of ischemia. In clinical practice, relevance lies in identifying the myocardium that has the ability to recover its contractile reserve after revascularization. Methods to evaluate cellular integrity tend to have higher sensitivity, while the ones assessing contractile reserve have greater specificity, since a larger mass of viable myocytes is required in order to generate contractility change. Since there are many methods and different ways to detect viability, sensitivity and specificity vary widely. Dobutamine-cardiac magnetic resonance with late gadolinium enhancement has the best accuracy is this setting, giving important predictors of prognostic and revascularization benefit such as scar burden, contractile reserve and end-systolic volume index. The latter has shown differential benefit with revascularization in some recent trials. Finally, authors discuss interventional procedures in this population, focusing on coronary artery bypass grafting and evolution of evidence from CASS to post-STICH era.

Ischemic heart failure: A review of clinical status and meta-analysis of diagnosis and clinical management methods

“…Despite these serious clinical implications, IHF lacks a definite terminology [4]. Most IHF studies refer to the condition as ischemic left ventricle (LV) systolic dysfunction or ischemic cardiomyopathy [5][6][7]. Many other studies refer to IHF using its sequalae -ischemic heart disease (IHD) [3,8], acute coronary syndrome (ACS) [9,10], coronary heart disease (CHD) [11,12] or coronary atherosclerotic disease [13][14][15].…”

Pericardial fluid proteomic label-free quantification of differentially expressed proteins in ischemic heart disease patients with systolic dysfunction by nano-LC-ESI-MS/MS analysis

“…47 In concordance with the previous ndings, our results also validate the recapitulation of Hh signaling pathway in ischemic heart disease patients but more prominently in impaired (LVEF <45) group. 48 Considering that the Hh signaling pathway is essential for the formation of new coronary vessels, this nding signals an important adaptive mechanism in humans with LVSD. 49 KEGG pathway analysis also showed that pathways involved in the Metabolism of steroids (pathway proteins: albumin, oxysterol-binding protein-related protein 6, sterol regulatory element-binding protein 2), plasma lipoprotein remodelling (pathway proteins: albumin, apolipoprotein A-IV) and bile acid and bile salt metabolic pathways (pathway proteins: albumin, oxysterol-binding protein-related protein 6) were downregulated in impaired (LVEF <45) group as compared to the normal (LVEF $45) group.…”

Multimodality Imaging in Ischemic Cardiomyopathy

“…PET has a reasonable sensitivity, but still limited specificity [18]. While the quality of the images is very good, still the technique is quite expensive [19]. Stress tests combined with nuclear techniques are novel tests which help find the specific coronary vessel responible for the damaged tissue.…”