Abstract

The terms used to describe different states of myocardial health and disease are poorly defined. Imprecision and inconsistency in nomenclature can lead to difficulty in interpreting and applying trial outcomes to clinical practice. In particular, the terms ‘viable’ and ‘hibernating’ are commonly applied interchangeably and incorrectly to myocardium that exhibits chronic contractile dysfunction in patients with ischaemic heart disease. The range of inherent differences amongst imaging modalities used to define myocardial health and disease add further challenges to consistent definitions. The results of several large trials have led to renewed discussion about the classification of dysfunctional myocardial segments. This article aims to describe the diverse myocardial pathologies that may affect the myocardium in ischaemic heart disease and cardiomyopathy, and how they may be assessed with non-invasive imaging techniques in order to provide a taxonomy of myocardial dysfunction.

Highlights

  • Studies have demonstrated the benefits of pharmacological[1,2,3,4,5,6,7,8] and device interventions[9] for patients with left ventricular systolic dysfunction (LVSD) of ischaemic origin

  • Tissue Doppler imaging (TDI) adds quantification of myocardial motion and global longitudinal strain can be used to detect subtle systolic and diastolic abnormalities that may have greater prognostic value compared with LVEF.[13,14]

  • Cine Cardiac magnetic resonance (CMR) with tissue tagging or feature tracking analysis allows quantitative assessment of segmental contractile function. Both echocardiography and CMR can be combined with pharmacological or physiological stress to detect ischaemia and viable, dysfunctional myocardium[17,18] through demonstration of contractile reserve

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Summary

Taxonomy of segmental myocardial systolic dysfunction

The terms used to describe different states of myocardial health and disease are poorly defined. Imprecision and inconsistency in nomenclature can lead to difficulty in interpreting and applying trial outcomes to clinical practice. The terms ‘viable’ and ‘hibernating’ are commonly applied interchangeably and incorrectly to myocardium that exhibits chronic contractile dysfunction in patients with ischaemic heart disease. The range of inherent differences amongst imaging modalities used to define myocardial health and disease add further challenges to consistent definitions. The results of several large trials have led to renewed discussion about the classification of dysfunctional myocardial segments. This article aims to describe the diverse myocardial pathologies that may affect the myocardium in ischaemic heart disease and cardiomyopathy, and how they may be assessed with non-invasive imaging techniques in order to provide a taxonomy of myocardial dysfunction

Introduction
Function and morphology
Tissue characterization
Future directions
Exposure to ionising radiation
Myopathic myocardium
Clinical implications
Findings
Conclusion

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