Abstract
The effects of coronary revascularization in patients with left ventricle systolic dysfunction (LVSD) are not well studied. The decision about revascularization and its timing remain challenging, not only related to procedural risk, but also linked to other several limitations including assessment of ischemia, viability, and ability to predict LV recovery. The role of viability as a prognostic marker for patients with LVSD and its use as a therapeutic target remains debatable. In this article, we will review the role of LVSD in patients undergoing coronary revascularization alongside the role of ischemia and viability assessment. We will provide a review of the literature on the outcomes of coronary revascularization, both surgically and percutaneously, in patients with LVSD.
Highlights
The key goal of performing coronary revascularization is to reduce anginal symptom, decrease the burden of ischemic myocardium and to improve patients’ clinical outcomes [1]
The benefits were extended to the elderly population in the Trial of Invasive versus Medical therapy in Elderly patients (TIME) trial, whereby percutaneous coronary intervention (PCI) led to a decrease in symptomatic burden and improved quality of life [3]
The Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) II trial reported a borderline reduction in myocardial infarction in patients who underwent physiology-guided coronary revascularization when compared to medical therapy [5,6]
Summary
The key goal of performing coronary revascularization is to reduce anginal symptom, decrease the burden of ischemic myocardium and to improve patients’ clinical outcomes [1]. In the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) nuclear sub-study, coronary revascularization reduced ischemia burden on serial myocardial perfusion scans This effect was more evident in patients with moderate to severe myocardial ischemia at outset [4]. Despite the benefits of coronary revascularization, patients with significant left ventricular systolic dysfunction (LVSD) remain clinically challenging. The International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) trial highlighted lower cardiac events in patients with at least moderate documented ischemia, on imaging tests or severe ischemia on exercise tests, and heart failure (HF) or left ventricular dysfunction (ejection fraction 35–45%) in the invasive group when compared to the conservative group [11]. In patients presenting with at least moderate ischemia but without heart failure symptoms or LVSD, there was no statistical difference in major cardiac events between the invasive (both coronary artery bypass graft, CABG, and PCI). The current review provides an overview of contemporary studies looking at the role of LV systolic dysfunction and the impact of revascularization when added to optimal medical treatment in these patients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
