Myocardial viability for decision-making concerning revascularization in patients with left ventricular dysfunction and coronary artery disease: A meta-analysis of non-randomized and randomized studies

Orlandini, Andrés; Castellana, Noelia; Pascual, Andrea; Botto, Fernando; Bahit, María Cecilia; Chacón, Carolina; Díaz, Manuel; Dı́az, Rafael

doi:10.1016/j.ijcard.2015.01.025

Cited by 54 publications

(31 citation statements)

References 43 publications

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“…The lower mortality that was observed in patients with CAD might, in our opinion, be explained by a contributory effect of myocardial revascularization on recovery by recruiting viable but hibernating areas 35 .…”

Section: Discussionmentioning

confidence: 78%

Prognostic Value of Right Ventricular Dysfunction and Tricuspid Regurgitation in Patients with Severe Low-Flow Low-Gradient Aortic Stenosis

Zilberszac

Gleiß

Schweitzer

et al. 2019

Sci Rep

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Long and mid-term data in Low-Flow Low-Gradient Aortic Stenosis (LFLG-AS) are scarce. The present study sought to identify predictors of outcome in a sizeable cohort of patients with LFLG-AS. 76 consecutive patients with LFLG-AS (defined by a mean gradient <40 mmHg, an aortic valve area ≤1 cm2 and an ejection fraction ≤50%) were prospectively enrolled and followed at regular intervals. Events defined as aortic valve replacement (AVR) and death were assessed and overall survival was determined. 44 patients underwent AVR (10 transcatheter and 34 surgical) whilst intervention was not performed in 32 patients, including 9 patients that died during a median waiting time of 4 months. Survival was significantly better after AVR with survival rates of 91.8% (CI 71.1–97.9%), 83.0% (CI 60.7–93.3%) and 56.3% (CI 32.1–74.8%) at 1,2 and 5 years as compared to 84.3% (CI 66.2–93.1%), 52.9% (CI 33.7–69.0%) and 30.3% (CI 14.6–47.5%), respectively, for patients managed conservatively (p = 0.017). The presence of right ventricular dysfunction (HR 3.47 [1.70–7.09]) and significant tricuspid regurgitation (TR) (HR 2.23 [1.13–4.39]) independently predicted overall mortality while the presence of significant TR (HR 3.40[1.38–8.35]) and higher aortic jet velocity (HR 0.91[0.82–1.00]) were independent predictors of mortality and survival after AVR. AVR is associated with improved long-term survival in patients with LFLG-AS. Treatment delays are associated with excessive mortality, warranting urgent treatment in eligible patients. Right ventricular involvement characterized by the presence of TR and/or right ventricular dysfunction, identifies patients at high risk of mortality under both conservative management and after AVR.

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Section: Discussionmentioning

confidence: 78%

Prognostic Value of Right Ventricular Dysfunction and Tricuspid Regurgitation in Patients with Severe Low-Flow Low-Gradient Aortic Stenosis

Zilberszac

Gleiß

Schweitzer

et al. 2019

Sci Rep

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“…55 A more recent meta-analysis of 32 observational studies demonstrated that patients with ICM and myocardial viability had a significant reduction in mortality with revascularisation compared to medical therapy only [7.3% vs. 27.4%, relative risk 0.31, 95% confidence interval (CI) 0.25-0.39] over a mean follow-up of 28 months. 56 So far, three randomised trials have examined the role of revascularisation in patients with ICM. The Heart Failure Revascularisation Trial (HEART), included only 138 of the initially planned 800 patients as the trial was prematurely terminated because of withdrawal of funding due to slow recruitment.…”

Section: Revascularisation and Device Therapy In The Management Of Ismentioning

confidence: 99%

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

Cabac-Pogorevici

Muk

Rustamova

et al. 2020

European J of Heart Fail

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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.

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“…In contrast, the Surgical Treatment of Ischemic Heart Failure (STICH) viability substudy showed that identification of viable myocardium by Single-photon Emission Computed Tomography (SPECT) or Dobutamine stress echocardiography did not add prognostic value in patients selected for coronary artery bypass grafting (CABG) (10). In brief, non-invasive myocardial viability testing in contemporary practice of managing ischemic LV dysfunction remains somewhat controversial and its prognostic value is a debating issue (6,(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Limited prognostic value of myocardial viability assessment in patients with coronary artery diseases and severe left ventricular dysfunction

et al. 2018

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Myocardial viability for decision-making concerning revascularization in patients with left ventricular dysfunction and coronary artery disease: A meta-analysis of non-randomized and randomized studies

Cited by 54 publications

References 43 publications

Prognostic Value of Right Ventricular Dysfunction and Tricuspid Regurgitation in Patients with Severe Low-Flow Low-Gradient Aortic Stenosis

Prognostic Value of Right Ventricular Dysfunction and Tricuspid Regurgitation in Patients with Severe Low-Flow Low-Gradient Aortic Stenosis

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

Limited prognostic value of myocardial viability assessment in patients with coronary artery diseases and severe left ventricular dysfunction

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