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Myocardial Viability And Survival In Ischemic Left Ventricular Dysfunction Pdf

myocardial viability and survival in ischemic left ventricular dysfunction pdf

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Published: 14.12.2020

Box , Doha, Qatar. Some patients with chronic ischemic left ventricular dysfunction have shown significant improvements of contractility with favorable long-term prognosis after revascularization. Several imaging techniques are available for the assessment of viable myocardium, based on the detection of preserved perfusion, preserved glucose metabolism, intact cell membrane and mitochondria, and presence of contractile reserve. Nuclear cardiology techniques, dobutamine echocardiography and positron emission tomography are used to assess myocardial viability. In recent years, new advances have improved methods of detecting myocardial viability.

Myocardial Viability: What We Knew and What Is New

Metrics details. Percutaneous coronary interventions PCI in patients with ischemic systolic left ventricular dysfunction SLVD are routinely performed although their impact on prognosis remains unclear. Of note, PCI significantly reduced the symptom of angina from On the other hand, performing a stress testing before PCI seems to be associated with a more favorable outcome. Peer Review reports. Interestingly, a clearcut survival benefit of revascularization in comparison to medical treatment has never been demonstrated [ 4 — 7 ], Although benefits both on mortality and rate of hospitalization can be achieved with CABG [ 8 , 9 ], In addition, HF-REF patients with moderate-to-severe systolic dysfunction, i.

NEJM Journal Watch

Background: Myocardial viability assessment in revascularization of ischemic heart failure remains controversial. This study evaluated the prognostic utility of cardiac magnetic resonance CMR late gadolinium enhancement LGE in ischemic heart failure. Analyses were stratified by treatment. Overall and anterior viability were assessed. Outcomes were all-cause mortality, cardiovascular CV mortality and major adverse CV events. A greater number of non-viable segments was significantly associated with higher all-cause and CV mortality in the CABG group adjusted hazard ratios 1. Anterior wall viability did not affect outcomes.


METHODS: In a substudy of patients with coronary artery disease and left ventricular dysfunction who were enrolled in a randomized trial of.


Myocardial Viability: What We Knew and What Is New

Harlan M. N Engl J Med Aug

Chronic heart failure is a major public-health problem with a high prevalence, complex treatment, and high mortality. A careful and comprehensive analysis is needed to provide optimal and personalized therapy to heart failure patients. The main 4 non-invasive imaging techniques echocardiography, magnetic resonance imaging, multi-detector-computed tomography, and nuclear imaging provide information on cardiovascular anatomy and function, which form the basis of the assessment of the pathophysiology underlying heart failure. This complete information will enable personalized treatment of the patient with ischemic heart failure. Chronic heart failure has become one of the clinically most important diseases of the heart.

Ischemic heart failure is a growing disease with high morbidity and mortality. Several studies suggest the benefit of viability imaging to assist revascularization decision, but there is controversy. Multiple imaging modalities can be used to accurately define hibernating myocardium; however, the best approach remains uncertain. This review will highlight current evidence and future directions of viability imaging assessment. Ischemic heart failure HF is the leading cause of HF and an epidemic disease worldwide with growing prevalence and high mortality rate.

B, Data were fit using linear regression. A, Inverse relationship between scar burden and change in regional systolic wall thickening after revascularization. C, Inverse relationship between scar burden within the thinned region and change in global left ventricular LV ejection fraction. A, Before revascularization, cine-CMR still frames in systole and diastole demonstrate akinesis and thinning of the anteroseptal, anterior, and apical walls. C, After revascularization, cine-CMR still frames demonstrate improvement in myocardial contractility along with reversal of thinning in the previously thinned region.

NEJM Journal Watch

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4 Comments

  1. Fleurette G.

    15.12.2020 at 02:42
    Reply

    * A list of the investigators in the Surgical. Treatment for Ischemic Heart Failure. (​STICH) trial is provided in the Supple- mentary Appendix.

  2. Delmare D.

    19.12.2020 at 18:19
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  3. Titiligny

    19.12.2020 at 19:11
    Reply

    The aim of revascularizing the infarct-related coronary artery IRCA is to restore interrupted or reduced blood flow, as well as to achieve some degree of functional recovery, avoid ventricular remodeling, and improve prognosis.

  4. Lothair L.

    22.12.2020 at 08:38
    Reply

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