Revascularization of hibernating myocardium (HM) (1–5) improves or normalizes left ventricular (LV) ejection fraction (EF) and the patient’s New York Heart Association functional class (6). Allman et al. (7) have analyzed data from 24 studies involving 3,088 patients who had LVEF of 0.32 0.08 and follow-up at 25 10 months. Patients who had revascularization when compared to “medical therapy” showed that (7): 1) in those with HM, See page 969 mortality was lower (3.2% vs. 16.0 %, p 0.0001), and 2) the lower the LVEF, the greater was the reduction in mortality. In addition, the composite of subsequent myocardial infarction (MI), heart failure, and unstable angina was also lower (6.0% vs. 12.2%, p 0.001) (8). These benefits were not seen in patients without HM but who nonetheless had been revascularized (7,8). In this issue of the Journal, Ambrosio et al. (9) have presented the findings of a carefully performed study which shows that in patients with either non–Q-wave MI or no previous MI but with LV wall motion abnormality and HM, there is remodeling of the LV; that is, LV enddiastolic volume (EDV) and end–systolic volume (ESV) are increased and the LV is more spherical. Thus, they have documented that the mere presence of LV systolic dysfunction with HM can lead to LV remodeling.
HYBERNATING MYOCARDIUM. ANOTHER PIECE OF THE PUZZLE FALLS INTO PLACE
FERRARI, Roberto
2006
Abstract
Revascularization of hibernating myocardium (HM) (1–5) improves or normalizes left ventricular (LV) ejection fraction (EF) and the patient’s New York Heart Association functional class (6). Allman et al. (7) have analyzed data from 24 studies involving 3,088 patients who had LVEF of 0.32 0.08 and follow-up at 25 10 months. Patients who had revascularization when compared to “medical therapy” showed that (7): 1) in those with HM, See page 969 mortality was lower (3.2% vs. 16.0 %, p 0.0001), and 2) the lower the LVEF, the greater was the reduction in mortality. In addition, the composite of subsequent myocardial infarction (MI), heart failure, and unstable angina was also lower (6.0% vs. 12.2%, p 0.001) (8). These benefits were not seen in patients without HM but who nonetheless had been revascularized (7,8). In this issue of the Journal, Ambrosio et al. (9) have presented the findings of a carefully performed study which shows that in patients with either non–Q-wave MI or no previous MI but with LV wall motion abnormality and HM, there is remodeling of the LV; that is, LV enddiastolic volume (EDV) and end–systolic volume (ESV) are increased and the LV is more spherical. Thus, they have documented that the mere presence of LV systolic dysfunction with HM can lead to LV remodeling.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
