Ischemic left ventricle systolic dysfunction: An evidence-based approach in diagnostic tools and therapeutics

Detalhes bibliográficos
Autor(a) principal: Lima,Eduardo Gomes
Data de Publicação: 2017
Outros Autores: Carvalho,Felipe Pereira Câmara de, Linhares Filho,Jaime Paula Pessoa, Pitta,Fabio Grunspun, Serrano Jr,Carlos Vicente
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Revista da Associação Médica Brasileira (Online)
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302017000900793
Resumo: Summary Coronary artery disease (CAD) associated with left ventricular systolic dysfunction is a condition related to poor prognosis. There is a lack of robust evidence in many aspects related to this condition, from definition to treatment. Ischemic cardiomyopathy is a spectrum ranging from stunned myocardium associated with myocardial fibrosis to hibernating myocardium and repetitive episodes of ischemia. In clinical practice, relevance lies in identifying the myocardium that has the ability to recover its contractile reserve after revascularization. Methods to evaluate cellular integrity tend to have higher sensitivity, while the ones assessing contractile reserve have greater specificity, since a larger mass of viable myocytes is required in order to generate contractility change. Since there are many methods and different ways to detect viability, sensitivity and specificity vary widely. Dobutamine-cardiac magnetic resonance with late gadolinium enhancement has the best accuracy is this setting, giving important predictors of prognostic and revascularization benefit such as scar burden, contractile reserve and end-systolic volume index. The latter has shown differential benefit with revascularization in some recent trials. Finally, authors discuss interventional procedures in this population, focusing on coronary artery bypass grafting and evolution of evidence from CASS to post-STICH era.
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spelling Ischemic left ventricle systolic dysfunction: An evidence-based approach in diagnostic tools and therapeuticscoronary artery diseaseheart failurecoronary artery bypass graftSummary Coronary artery disease (CAD) associated with left ventricular systolic dysfunction is a condition related to poor prognosis. There is a lack of robust evidence in many aspects related to this condition, from definition to treatment. Ischemic cardiomyopathy is a spectrum ranging from stunned myocardium associated with myocardial fibrosis to hibernating myocardium and repetitive episodes of ischemia. In clinical practice, relevance lies in identifying the myocardium that has the ability to recover its contractile reserve after revascularization. Methods to evaluate cellular integrity tend to have higher sensitivity, while the ones assessing contractile reserve have greater specificity, since a larger mass of viable myocytes is required in order to generate contractility change. Since there are many methods and different ways to detect viability, sensitivity and specificity vary widely. Dobutamine-cardiac magnetic resonance with late gadolinium enhancement has the best accuracy is this setting, giving important predictors of prognostic and revascularization benefit such as scar burden, contractile reserve and end-systolic volume index. The latter has shown differential benefit with revascularization in some recent trials. Finally, authors discuss interventional procedures in this population, focusing on coronary artery bypass grafting and evolution of evidence from CASS to post-STICH era.Associação Médica Brasileira2017-19-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302017000900793Revista da Associação Médica Brasileira v.63 n.9 2017reponame:Revista da Associação Médica Brasileira (Online)instname:Associação Médica Brasileira (AMB)instacron:AMB10.1590/1806-9282.63.09.793info:eu-repo/semantics/openAccessLima,Eduardo GomesCarvalho,Felipe Pereira Câmara deLinhares Filho,Jaime Paula PessoaPitta,Fabio GrunspunSerrano Jr,Carlos Vicenteeng2018-02-22T00:00:00Zoai:scielo:S0104-42302017000900793Revistahttps://ramb.amb.org.br/ultimas-edicoes/#https://old.scielo.br/oai/scielo-oai.php||ramb@amb.org.br1806-92820104-4230opendoar:2018-02-22T00:00Revista da Associação Médica Brasileira (Online) - Associação Médica Brasileira (AMB)false
dc.title.none.fl_str_mv Ischemic left ventricle systolic dysfunction: An evidence-based approach in diagnostic tools and therapeutics
title Ischemic left ventricle systolic dysfunction: An evidence-based approach in diagnostic tools and therapeutics
spellingShingle Ischemic left ventricle systolic dysfunction: An evidence-based approach in diagnostic tools and therapeutics
Lima,Eduardo Gomes
coronary artery disease
heart failure
coronary artery bypass graft
title_short Ischemic left ventricle systolic dysfunction: An evidence-based approach in diagnostic tools and therapeutics
title_full Ischemic left ventricle systolic dysfunction: An evidence-based approach in diagnostic tools and therapeutics
title_fullStr Ischemic left ventricle systolic dysfunction: An evidence-based approach in diagnostic tools and therapeutics
title_full_unstemmed Ischemic left ventricle systolic dysfunction: An evidence-based approach in diagnostic tools and therapeutics
title_sort Ischemic left ventricle systolic dysfunction: An evidence-based approach in diagnostic tools and therapeutics
author Lima,Eduardo Gomes
author_facet Lima,Eduardo Gomes
Carvalho,Felipe Pereira Câmara de
Linhares Filho,Jaime Paula Pessoa
Pitta,Fabio Grunspun
Serrano Jr,Carlos Vicente
author_role author
author2 Carvalho,Felipe Pereira Câmara de
Linhares Filho,Jaime Paula Pessoa
Pitta,Fabio Grunspun
Serrano Jr,Carlos Vicente
author2_role author
author
author
author
dc.contributor.author.fl_str_mv Lima,Eduardo Gomes
Carvalho,Felipe Pereira Câmara de
Linhares Filho,Jaime Paula Pessoa
Pitta,Fabio Grunspun
Serrano Jr,Carlos Vicente
dc.subject.por.fl_str_mv coronary artery disease
heart failure
coronary artery bypass graft
topic coronary artery disease
heart failure
coronary artery bypass graft
description Summary Coronary artery disease (CAD) associated with left ventricular systolic dysfunction is a condition related to poor prognosis. There is a lack of robust evidence in many aspects related to this condition, from definition to treatment. Ischemic cardiomyopathy is a spectrum ranging from stunned myocardium associated with myocardial fibrosis to hibernating myocardium and repetitive episodes of ischemia. In clinical practice, relevance lies in identifying the myocardium that has the ability to recover its contractile reserve after revascularization. Methods to evaluate cellular integrity tend to have higher sensitivity, while the ones assessing contractile reserve have greater specificity, since a larger mass of viable myocytes is required in order to generate contractility change. Since there are many methods and different ways to detect viability, sensitivity and specificity vary widely. Dobutamine-cardiac magnetic resonance with late gadolinium enhancement has the best accuracy is this setting, giving important predictors of prognostic and revascularization benefit such as scar burden, contractile reserve and end-systolic volume index. The latter has shown differential benefit with revascularization in some recent trials. Finally, authors discuss interventional procedures in this population, focusing on coronary artery bypass grafting and evolution of evidence from CASS to post-STICH era.
publishDate 2017
dc.date.none.fl_str_mv 2017-19-01
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
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dc.identifier.uri.fl_str_mv http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302017000900793
url http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302017000900793
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv 10.1590/1806-9282.63.09.793
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dc.format.none.fl_str_mv text/html
dc.publisher.none.fl_str_mv Associação Médica Brasileira
publisher.none.fl_str_mv Associação Médica Brasileira
dc.source.none.fl_str_mv Revista da Associação Médica Brasileira v.63 n.9 2017
reponame:Revista da Associação Médica Brasileira (Online)
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instname_str Associação Médica Brasileira (AMB)
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reponame_str Revista da Associação Médica Brasileira (Online)
collection Revista da Associação Médica Brasileira (Online)
repository.name.fl_str_mv Revista da Associação Médica Brasileira (Online) - Associação Médica Brasileira (AMB)
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