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Chronic Ischemic Left Ventricular Dysfunction

From Pathophysiology to Imaging and its Integration Into Clinical Practice

Shahbudin H. Rahimtoola, MB, FRCP, MACP, MACC, DSc (Hon)^_*,_*, Vasken Dilsizian, MD, FACC, Christopher M. Kramer, MD, FACC, Thomas H. Marwick, MBBS, PhD, FRACP, FESC, FACC, Jean-Louis J. Vanoverschelde, MD, PhD, FACC^||

^_* Griffith Center, Division of Cardiovascular Medicine, Department of Medicine, LAC+USC Medical Center, University of Southern California, Los Angeles, California
Departments of Medicine and Radiology, University of Maryland Medical Center, Baltimore, Maryland
University of Virginia Health System, Departments of Medicine and Radiology, Charlottesville, Virginia
University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
^|| Division of Cardiology, Cliniques Universitaires St. Luc, Brussels, Belgium.

^_* Reprint requests and correspondence: Dr. Shahbudin H. Rahimtoola, University of Southern California, 2025 Zonal Avenue, GNH 7131, Los Angeles, California 90033. (Email: rahimtoo{at}usc.edu).

Chronic ischemic left ventricular dysfunction is present in a number of clinical syndromes in which myocardial revascularization results in an improvement of left ventricular function, patients' functional class, and their survival. Early diagnosis of and treatment of viability is essential. Coronary arteriography is of limited value in diagnosis of viability. Noninvasive testing is essential for diagnosis, which can be matched to the pathophysiologic changes that occur in hibernating myocardium. However, no single test has a perfect, or near perfect, sensitivity and specificity, and thus, a combination of tests are usually needed. Algorithms are developed to integrate these tests in clinical decision making.

Key Words: hibernation • heart failure • myocardial infarction • myocardial revascularization

Abbreviations and Acronyms   ATP = adenosine triphosphate   BMIPP = beta-methyl-p-[123I]-iodophenyl-pentadecanoic acid   CFR = coronary flow reserve   CMR = cardiac magnetic resonance   CR = contractile reserve   FDG = fluorodeoxyglucose   HM = hibernating myocardium   LDDE = low-dose dobutamine echocardiography   LGE = late gadolinium enhancement   LV = left ventricular   LVD = left ventricular dysfunction   LVEF = left ventricular ejection fraction   MBF = myocardial blood flow   MI = myocardial infarction   PET = positron emission tomography   SE-MBF = subendocardial MBF   SPECT = single-photon emission computed tomography   TM-MBF = transmural MBF