Percutaneous Coronary Intervention for Left Ventricular Systolic Dysfunction

  • Sophie Zhaotao Gu
  • Amr Gamal
  • Christopher Eggett
  • Hani Ali
  • Azfar Zaman
  • Richard Edwards
  • Vijay KunadianEmail author


Heart failure (HF) is a clinical syndrome with symptoms and signs caused by cardiac dysfunction. Its prevalence is estimated at 1–2% in the developed world with an incidence approaching 5–10 per 1000 persons per year. Ischemic heart disease (IHD) is the most common cause of heart failure in the developed world. Heart failure due to ischaemia is associated with worse mortality compared with a non-ischaemic cause. The term ischaemic cardiomyopathy (ICM) has been commonly used to describe impaired left ventricular systolic dysfunction (LVSD: ejection fraction ≤35–40%) resulting from coronary artery disease (CAD). This chapter focuses on the diagnosis and management of ischemic cardiomyopathy. We explore the current evidence base to aid clinical decision-making for invasive versus conservative management. Conventional pharmacological therapy for heart failure will not be discussed in detail in this chapter.


Heart failure Ischemic cardiomyopathy Hibernating/viable myocardium Viability testing Revascularization Percutaneous coronary intervention Coronary artery bypass graft Optimal medical therapy Takotsubo cardiomyopathy 


  1. 1.
    Freeman Hospital Services. [cited 2016 23 September].
  2. 2.
    Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–200.CrossRefGoogle Scholar
  3. 3.
    Mostered A, Hoes AW. Clinical epidemiology of heart failure. Heart. 2007;93:1137–46.CrossRefGoogle Scholar
  4. 4.
    Felker GM, Shaw LK, O’Connor CM. A standardized definition of ischemic cardiomyopathy for use in clinical research. J Am Coll Cardiol. 2002;39:210–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Briceno N, Schuster A, Lumley M, Perera D. Ischaemic cardiomyopathy: pathophysiology, assessment and the role of revascularisation. Heart. 2016;102(5):397–406.CrossRefPubMedGoogle Scholar
  6. 6.
    Writing Committee Memebrs, Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;128(16):e240–327.CrossRefGoogle Scholar
  7. 7.
    Yao SS, Chaudhry FA. Assessment of myocardial viability with dobutamine stress echocardiography in patients with ischaemic left ventricular dysfunction. Echocardiography. 2005;22:71–83.CrossRefPubMedGoogle Scholar
  8. 8.
    Underwood SR, Bax JJ, Vom Dahl J, et al. Imaging techniques for the assessment of myocardial hibernation: report of a study group of the European society of Cardiology. Eur Heart J. 2004;25:815–36.CrossRefPubMedGoogle Scholar
  9. 9.
    Auerbach MA, Schöder H, Hoh C, et al. Prevalence of myocardial viability as detected by positron emission tomography in patients with ischaemic cardiomopathy. Circulation. 1999;99:2921–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Nagel E, Schuster A. Myocardial viability: dead or alive is not the question! JACC Cardiovasc Imaging. 2012;5:509–12.CrossRefPubMedGoogle Scholar
  11. 11.
    Allman KC, Shaw LJ, Hachamovitch R, Udelson JE. Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis. J Am Coll Cardiol. 2002;39(7):1151–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Bourque JM, Hasselblad V, Velazquez EJ, Borges-Neto S, O’Connor CM. Revascularization in patients with coronary artery disease, left ventricular dysfunction, and viability: a meta-analysis. Am Heart J. 2003;146:621–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Bonow RO, Maurer G, Lee KL, et al. STICH Trial Investigators. Myocardial viability and survival in ischaemic left ventricular dysfunction. N Engl J Med. 2011;364:1617–25.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Velazquez EJ, Lee KL, O’Connor CM, Oh JK, Bonow RO, Pohost GM, et al. The rationale and design of the surgical treatment for IsChemic heart failure (STICH) trial. J Thorac Cardiovasc Surg. 2007;134(6):1540–7.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Velazquez EJ, Lee KL, Deja MA, et al. Coronary-artery bypass surgery in patients with left ventricular dysfunction. N Engl J Med. 2011;364:1607–16.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Carson P, Wertheimer J, Miller A, et al. The STICH trial mode-of-death results. JACC Heart Fail. 2013;1(5):400–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Velazquez EJ, Lee KL, Jones RH, et al. Coronary-artery bypass surgery in patients with ischemic cardiomyopathy. N Engl J Med. 2016;374(16):1511–20.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Authors/Task Force Members, Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;35(37):2541–619.CrossRefGoogle Scholar
  19. 19.
    Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;124(23):e652–735.CrossRefPubMedGoogle Scholar
  20. 20.
    Kunadian V, Zaman A, Qiu W. Revascularization among patients with severe left ventricular dysfunction: a meta-analysis of observational studies. Eur J Heart Fail. 2011;13(7):773–84.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Mohr FW, Morice M-C, Kappetein AP, Feldman TE, Ståhle E, Colombo A, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet. 2013;381(9867):629–38.CrossRefPubMedGoogle Scholar
  22. 22.
    Davierwala P, Mohr FW. Five years after the SYNTAX trial: what have we learnt? Eur J Cardiothorac Surg. 2013;44(1):1–3.CrossRefPubMedGoogle Scholar
  23. 23.
    Kunadian V, Pugh A, Zaman A, Qiu W. Percutaneous coronary intervention among patients with left ventricular systolic dysfunction: a review and meta-analysis of 19 clinical studies. Coron Artery Dis. 2012;23(7):469–79.CrossRefPubMedGoogle Scholar
  24. 24.
    Cleland JG, Calvert M, Freemantle N, Arrow Y, Ball SG, Bonser RS, et al. The Heart Failure Revascularisation Trial (HEART). Eur J Heart Fail. 2011;13(2):227–33.CrossRefPubMedGoogle Scholar
  25. 25.
    Perera D, Stables R, Thomas M, et al. Elective intra-aortic balloon counterpulsation during high-risk percutaneous coronary intervention: a randomized controlled trial. JAMA. 2010;304(8):867–74.CrossRefPubMedGoogle Scholar
  26. 26.
    Perera D, Stables R, Clayton T, De Silva K, Lumley M, Clack L, et al. Long-term mortality data from the balloon pump-assisted coronary intervention study (BCIS-1): a randomized, controlled trial of elective balloon counterpulsation during high-risk percutaneous coronary intervention. Circulation. 2013;127(2):207–12.CrossRefPubMedGoogle Scholar
  27. 27.
    REVIVED-BCIS-2 trial protocol [cited 2016 23 September]. NCT01920048.
  28. 28.
    Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, et al. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement From the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation. 2006;113(14):1807–16.CrossRefGoogle Scholar
  29. 29.
    Parodi G, Del Pace S, Carrabba N, Salvadori C, Memisha G, Simonetti I, et al. Incidence, clinical findings, and outcome of women with left ventricular apical ballooning syndrome. Am J Cardiol. 2007;99(2):182–5.CrossRefPubMedGoogle Scholar
  30. 30.
    Kurisu S, Sato H, Kawagoe T, Ishihara M, Shimatani Y, Nishioka K, et al. Tako-tsubo-like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction. Am Heart J. 2002;143(3):448–55.CrossRefPubMedGoogle Scholar
  31. 31.
    Tsuchihashi K, Ueshima K, Uchida T, Oh-mura N, Kimura K, Owa M, et al. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. J Am Coll Cardiol. 2001;38(1):11–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Azzarelli S, Galassi AR, Amico F, Giacoppo M, Argentino V, Tomasello SD, et al. Clinical features of transient left ventricular apical ballooning. Am J Cardiol. 2006;98(9):1273–6.CrossRefPubMedGoogle Scholar
  33. 33.
    Haghi D, Fluechter S, Suselbeck T, Kaden JJ, Borggrefe M, Papavassiliu T. Cardiovascular magnetic resonance findings in typical versus atypical forms of the acute apical ballooning syndrome (Takotsubo cardiomyopathy). Int J Cardiol. 2007;120(2):205–11.CrossRefPubMedGoogle Scholar
  34. 34.
    Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J. 2008;155(3):408–17.CrossRefPubMedGoogle Scholar
  35. 35.
    Elesber AA, Prasad A, Lennon RJ, Wright RS, Lerman A, Rihal CS. Four-year recurrence rate and prognosis of the apical ballooning syndrome. J Am Coll Cardiol. 2007;50(5):448–52.CrossRefGoogle Scholar
  36. 36.
    Kurisu S, Inoue I, Kawagoe T, Ishihara M, Shimatani Y, Nakama Y, et al. Presentation of Tako-tsubo cardiomyopathy in men and women. Clin Cardiol. 2010;33(1):42–5.CrossRefPubMedGoogle Scholar
  37. 37.
    Bybee KA, Kara T, Prasad A, Lerman A, Barsness GW, Wright RS, et al. Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction. Ann Intern Med. 2004;141(11):858–65.CrossRefPubMedGoogle Scholar
  38. 38.
    Ghadri J-R, Wittstein IS, Prasad A, Sharkey S, Dote K, Akashi YJ, Cammann VL, Crea F, Galiuto L, Desmet W, Yoshida T, Manfredini R, Eitel I, Kosuge M, Nef HM, Deshmukh A, Lerman A, Bossone E, Citro R, Ueyama T, Corrado D, Kurisu S, Ruschitzka F, Winchester D, Lyon AR, Omerovic E, Bax JJ, Meimoun P, Tarantini G, Rihal C, Shams Y-H, Migliore F, Horowitz JD, Shimokawa H, Lüscher TF, Templin C. International expert consensus document on Takotsubo Syndrome (Part I): clinical characteristics, diagnostic criteria, and pathophysiology. European Heart Journal. 2018;39(22):2032–46. Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Sophie Zhaotao Gu
    • 1
    • 2
  • Amr Gamal
    • 3
  • Christopher Eggett
    • 3
  • Hani Ali
    • 1
    • 2
  • Azfar Zaman
    • 1
    • 2
  • Richard Edwards
    • 3
  • Vijay Kunadian
    • 1
    • 2
    Email author
  1. 1.Institute of Cellular MedicineNewcastle UniversityNewcastle upon TyneUK
  2. 2.Cardiothoracic Centre, Freeman HospitalNewcastle upon Tyne NHS Foundation TrustNewcastle upon TyneUK
  3. 3.Cardiothoracic Centre, Freeman HospitalNewcastle upon Tyne NHS Foundation TrustNewcastle upon TyneUK

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