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Relief of Ischemia in Ischemic Cardiomyopathy

  • Myocardial Disease (A Abbate and G Sinagra, Section Editors)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of the Review

Ischemic heart disease is among the most common causes of morbidity and mortality worldwide. In its stable manifestation, obstructing coronary artery stenoses prevent myocardial blood flow from matching metabolic needs of the heart under exercise conditions, which manifests clinically as dyspnea or chest pain. Prolonged bouts of ischemia may result in permanent myocardial dysfunction, heart failure, and eventually reduced survival. The aim of the present work is to review currently available approaches to provide relief of ischemia in stable coronary artery disease (CAD).

Recent Findings

Several pharmacological and interventional approaches have proven effectiveness in reducing the burden of ischemia in stable CAD and allow for symptom control and quality of life improvement. However, substantial evidence in favor of improved survival with ischemia relief is lacking, and recently published randomized controlled trial suggests that only selected groups of patients may substantially benefit from this approach.

Summary

Pharmacological treatments aimed at reducing ischemia were shown to significantly reduce ischemic symptoms but failed to provide prognostic benefit. Myocardial revascularization is able to re-establish adequate coronary artery flow and was shown to improve survival in selected groups of patients, i.e., those with significant left main CAD or severe left ventricular dysfunction in multivessel CAD. Outside the previously mentioned categories, revascularization appears to improve symptoms control over medical therapy, but does not confer prognostic advantage. More studies are needed to elucidate the role of systematic invasive functional testing to identify individuals more likely to benefit from revascularization and to evaluate the prognostic role of chronic total occlusion recanalization.

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Authors and Affiliations

  1. Università Vita-Salute San Raffaele, Milan, Italy

    Francesco Moroni

  2. Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, West Hospital, 5th floor, West wing, 1200 East Broad St, Richmond, VA, USA

    Francesco Moroni

  3. Division of Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, West Hospital, 5th floor, West wing, Room 526 1200 East Broad St, Richmond, VA, USA

    Zachary Gertz & Lorenzo Azzalini

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  1. Francesco Moroni
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  2. Zachary Gertz
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  3. Lorenzo Azzalini
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Correspondence to Lorenzo Azzalini.

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Moroni, F., Gertz, Z. & Azzalini, L. Relief of Ischemia in Ischemic Cardiomyopathy. Curr Cardiol Rep 23, 80 (2021). https://doi.org/10.1007/s11886-021-01520-4

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