skip to main content
Idioma:
Primo Search
Clear Search Box
Search in: Busca Geral
Busca Avançada
Busca por Índices

Myocardial viability testing: all STICHed up, or about to be REVIVED?

Ryan, Matthew ; Morgan, Holly ; Chiribiri, Amedeo ; Nagel, Eike ; Cleland, John ; Perera, Divaka

European heart journal, 2022-01, Vol.43 (2), p.118-126 [Periódico revisado por pares]

England: Oxford University Press

Texto completo disponível

Citações Citado por
  • Título:
    Myocardial viability testing: all STICHed up, or about to be REVIVED?
  • Autor: Ryan, Matthew ; Morgan, Holly ; Chiribiri, Amedeo ; Nagel, Eike ; Cleland, John ; Perera, Divaka
  • Assuntos: Coronary Artery Bypass ; Humans ; Myocardial Ischemia ; Myocardial Revascularization ; Myocardium ; Prognosis ; State of the Art Review ; Ventricular Dysfunction, Left
  • É parte de: European heart journal, 2022-01, Vol.43 (2), p.118-126
  • Notas: ObjectType-Article-1
    SourceType-Scholarly Journals-1
    ObjectType-Feature-2
    content type line 23
  • Descrição: Abstract Patients with ischaemic left ventricular dysfunction frequently undergo myocardial viability testing. The historical model presumes that those who have extensive areas of dysfunctional-yet-viable myocardium derive particular benefit from revascularization, whilst those without extensive viability do not. These suppositions rely on the theory of hibernation and are based on data of low quality: taking a dogmatic approach may therefore lead to patients being refused appropriate, prognostically important treatment. Recent data from a sub-study of the randomized STICH trial challenges these historical concepts, as the volume of viable myocardium failed to predict the effectiveness of coronary artery bypass grafting. Should the Heart Team now abandon viability testing, or are new paradigms needed in the way we interpret viability? This state-of-the-art review critically examines the evidence base for viability testing, focusing in particular on the presumed interactions between viability, functional recovery, revascularization and prognosis which underly the traditional model. We consider whether viability should relate solely to dysfunctional myocardium or be considered more broadly and explore wider uses of viability testingoutside of revascularization decision-making. Finally, we look forward to ongoing and future randomized trials, which will shape evidence-based clinical practice in the future. Graphical Abstract Graphical Abstract Evidence for the relationship between viability testing and clinical outcomes. Viability and prognosis: the STICH viability sub-study showed viability had no impact on prognosis after adjustment for baseline variables.3 Viability and prognostic benefit of revascularization: no association shown in the STICH viability sub-study, however, has been shown in PARR-2 substudy and observational data;27,40 * will be further explored in the ongoing REVIVED trial.62 Viability and functional recovery: a relationship has been demonstrated for medical therapy.14 Viability to functional recovery via revascularization—no association shown in randomised controlled trials (RCTs), but extensive observational data.2 A link between functional recovery and prognosis is suggested from long-term STICH follow-up data.19 A link between revascularization and prognosis was shown for CABG in the STICH trial (long-term follow-up, not seen in HEART trial).
  • Editor: England: Oxford University Press
  • Idioma: Inglês
Links
Voltar para lista de resultados

  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

Buscando em bases de dados remotas. Favor aguardar.