Document Detail

Clinical benefit of noninvasive viability studies of patients with severe ischemic left ventricular dysfunction.
MedLine Citation:
PMID:  11403503     Owner:  NLM     Status:  MEDLINE    
The population of patients who have congestive heart failure of ischemic origin is large and growing. It imposes a heavy burden on human suffering and economic costs such as the chronic use of costly medications, recurrent hospital admissions, and, eventually, death or the necessity of heart transplantation. Therefore, the development of methods for detecting viable myocardium may allow the accurate selection of those patients with coronary artery disease with severe left ventricular dysfunction who are most likely to benefit from revascularization, but also excludes patients who are unlikely to obtain any improvement with revascularization techniques. The presence of reversible dysfunctional myocardium that may improve after revascularization implies the concepts of stunned and hibernating myocardium. Recent evidence suggests that hibernation may not be a stable condition since it might evolve toward an irreversible dysfunction if it is not revascularized at the right moment. The techniques available for viability studies are single-photon emission computed tomography using thallium-201 or compounds labeled with technetium-99m, positron emission tomography, and dobutamine stress echocardiography. Newer and promising techniques are magnetic resonance imaging and contrast echocardiography, whose definitive roles are not clear yet. There is abundant evidence from several important studies showing that patients with a significant amount of viable myocardium have a poor outcome if they are treated medically. Conversely, if these patients are revascularized, their outcomes improve and their symptoms significantly decrease, with less necessity of medication, fewer admissions to the hospital, and even in some cases avoiding heart transplantation. On the other hand, patients with poor or no viability who are revascularized do not obtain significant benefit.
J R Soto; G A Beller
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Clinical cardiology     Volume:  24     ISSN:  0160-9289     ISO Abbreviation:  Clin Cardiol     Publication Date:  2001 Jun 
Date Detail:
Created Date:  2001-06-13     Completed Date:  2001-11-01     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  7903272     Medline TA:  Clin Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  428-34     Citation Subset:  IM    
Department of Medicine, University of Virginia Health System, Charlottesville 22908-0158, USA.
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MeSH Terms
Coronary Disease / radionuclide imaging
Myocardial Ischemia / radionuclide imaging*
Myocardial Revascularization
Myocardial Stunning / radionuclide imaging*
Tomography, Emission-Computed
Tomography, Emission-Computed, Single-Photon
Ventricular Dysfunction, Left / radionuclide imaging*

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