Revascularization in heart failure in the post-STICH era.
Revascularization in heart failure in the post-STICH era.
复制标题
后 STICH 时代心力衰竭的血运重建。
DOI：
10.1007/s11897-013-0168-2
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发表时间：
2013
影响因子：
--
通讯作者：
Kwon,DeborahH
中科院分区：
文献类型：
--
作者：
Jha,Saurabh;Flamm,ScottD;Kwon,DeborahH
冠状动脉疾病继发性缺血引起的左心室功能障碍不仅是心肌细胞死亡的结果，也是由于顿抑和冬眠，这是潜在的可逆现象。心肌存活试验常用于缺血性心肌病患者，以预测血运重建后收缩功能的恢复。尽管几项观察性研究支持使用活力测试，但缺血性心力衰竭手术治疗（斯蒂奇）活力子研究对其在临床决策中的作用提出了挑战，因为本研究中的活力测试无法预测基于治疗类型的不同结局，并且在接受血运重建的无活力患者中存在生存率增加的趋势。然而，由于研究设计和实施的局限性，斯蒂奇试验的结果引起了争议。需要使用高分辨率模式（如正电子发射断层扫描或延迟超增强心脏磁共振）进行随机对照试验，以确定基于心肌存活率的血运重建可能带来的增量获益。
Left ventricular (LV) dysfunction caused by ischemia secondary to coronary artery disease results not only from cardiac myocyte death but also from stunning and hibernation, which are potentially reversible phenomena. Myocardial viability testing is often used in patients with ischemic cardiomyopathy to predict recovery of contractile function after revascularization. Although several observational studies have supported the use of viability testing, the Surgical Treatment for Ischemic Heart failure (STICH) viability substudy challenged its role in clinical decision-making, as viability testing in this study did not predict differential outcomes based on treatment type, and there was a trend toward increased survival in patients with no viability who underwent revascularization. However, the results of the STICH trial have caused controversy because of limitations in study design and implementation. Randomized controlled trials using high-resolution modalities such as positron emission tomography or delayed hyperenhancement cardiac magnetic resonance are needed to determine the incremental benefits that revascularization may afford based on myocardial viability.