Ischaemic cardiomyopathy. Pathophysiological insights, diagnostic management and the roles of revascularisation and device treatment. Gaps and dilemmas in the era of advanced technology

Abstract

Ischaemic cardiomyopathy (ICM) represents an important cardiovascular condition associated with substantially increased morbidity and mortality. It is characterised from a broad spectrum of clinical manifestations and pathophysiological substrates and its diagnosis is based on the demonstration of significant left ventricular dysfunction in the context of significant epicardial coronary artery disease. Contemporary management aims at improving prognosis through evidence-based pharmacotherapy and device therapy, where indicated. Whilst the beneficial role of revascularisation remains clear in patients with strong indications such as those with symptoms and/or acute coronary syndromes, for those patients that are asymptomatic and suffer from stable ischaemic heart disease the impact of revascularisation on hard outcomes remains less well defined and currently its adoption is hampered by the lack of robust randomised data. The aim of this review is therefore to provide a constructive appraisal on the pathophysiology of ICM, the role of the various non-invasive imaging techniques in the diagnosis of ICM and the differentiation between viable and non-viable myocardium and finally discourse the potential role of revascularisation and contemporary device therapy in the management of patients with ICM.

Review article: comprehensive analysis of cirrhotic cardiomyopathy

“…Thus, in addition to the alcohol history, patients with alcoholic cardiomyopathy show much more overt heart failure compared to CCM. Ischaemic cardiomyopathy is defined as left ventricular dysfunction in the presence of severe coronary artery disease 84 . Similar to alcoholic cardiomyopathy, ischaemic cardiomyopathy is more overt and severe than CCM.…”

Advances in Nanomaterials for Injured Heart Repair

“…This eventually results in the activation of apoptosis cascade and cell necrosis. Consequently, this process triggers a severe inflammatory response through an immune cascade, resulting in the activation of complements, the production of ROS, and the activation of inflammasomes ( Cabac-Pogorevici et al, 2020 ). The subsequent release of a variety of proinflammatory mediators (such as cytokines and chemokines) induces the recruitment of inflammatory cells into the lesions of MI and enhances the inflammatory response after MI.…”

“…Moreover, the currently available treatment strategies for AS only focus on the regulation of lipid metabolism while ignoring the reduction of inflammation. When ASCVD progresses to a severe stage, surgical treatment or thrombolytic therapy is the last option to boost blood perfusion and save dying cardiomyocytes ( Cabac-Pogorevici et al, 2020 ). Because of the occurrence of myocardial infarction (MI), even if a patient receives adequate treatment, a large number of cardiomyocytes will have either died or suffered irreversible injury, and reperfusion injury will further aggravate myocardial injury.…”

“…For a long time, scientists have been investigating the possible mechanisms related to the pathological process of ASCVD and regenerative repair, including oxidative stress, inflammation, calcium homeostasis disorders, lipid transport, apoptosis, and ventricular remodeling, aiming to discover innovative solutions to reverse the pathological process of AS and enhance the therapeutic effects of MI treatments ( Zhang et al, 2017 ; Chan et al, 2018 ; Wu et al, 2018 ; Cabac-Pogorevici et al, 2020 ; Hu et al, 2020 ). A consistent gap exists, however, in the translation of these research advances into downstream clinical applications.…”

May 2020 at a glance: ischaemic heart failure and sex‐related differences

“…The role of coronary revascularization in asymptomatic patients with HF of ischaemic aetiology remains debated 5 . A comprehensive review showing the pathophysiology and diagnosis of this condition, as well as the role of coronary revascularization, is reported in this issue 6 . Thuijs et al 7 .…”