Current Heart Failure Reports

, Volume 12, Issue 2, pp 112–119 | Cite as

The Benefits of Revascularization in Chronic Heart Failure

Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise (AK Hasan, Section Editor)
First Online:
Part of the following topical collections:
  1. Topical Collection on Nonpharmacologic Therapy: Surgery, Ventricular Assist Devices, Biventricular Pacing, and Exercise

Abstract

Recent efforts have reduced the mortality from coronary artery disease (CAD), with the consequent increase in heart failure with reduced left ventricular function, referred to as ischaemic cardiomyopathy (ICM). As ischemic left ventricular (LV) dysfunction may be partially or completely reversible by revascularization in the presence of viable myocardium, the assessment of myocardial viability is central to the management of ICM. Decades of observational analyses have provided positive evidence for the role of revascularization in hibernating myocardium in improving survival. However, recently the Surgical Treatment for Ischaemic Heart Failure (STICH) trial has challenged this notion, highlighting the noninferiority of optimal medical therapy (OMT) over revascularization and OMT. In this review, we discuss noninvasive imaging modalities to assess myocardial viability and the impact of myocardial viability on revascularization. We critically appraise the STICH trial and suggest an algorithm for viability testing before revascularization in patients with ICM and significant LV dysfunction.

Keywords

Revascularization Ischemic cardiomyopathy STICH trial Viability Heart failure 
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Notes

Compliance with Ethics Guidelines

Conflict of Interest

Sothinathan Gurunathan, Asrar Ahmed and Roxy Senior declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Sothinathan Gurunathan
    • 1
  • Asrar Ahmed
    • 1
  • Roxy Senior
    • 1
    • 2
  1. 1.Department of CardiologyNorthwick Park HospitalHarrowUK
  2. 2.Department of CardiologyRoyal Brompton Hospital, National Heart and Lung Institute, Imperial CollegeLondonUK

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