PubMed · 15644535
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Sujeeth R Punnam. 2005-01-12. Global risk score and exercise testing.. https://doi.org/10.1001/jama.293.2.159-c
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Angina pectoris, whether stable or unstable, is not the most common ischaemic manifestation of coronary heart disease. Silent or asymptomatic ischaemia is the most frequently encountered ischaemic event in coronary heart disease. nevertheless, its prevalence is very variable, depending on the studied population (2-4% in asymptomatic patients, 20-30% after an myocardial infarction, 40-60% in stable angina and 60-80% in unstable angina). In this context, silent ischaemia raises many questions with regards to the rational use of diagnostic tools (stress test, holter electrocardiographic recording and stress imaging tests), their prognostic interpretation and its management.
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Left ventricular systolic dysfunction is mainly a result of coronary artery disease (CAD). Decrease in myocardial contractility results as a response to a chronic hypoperfusion state that produces a change in cardiac myocyte metabolism, resulting in a perfusion-contraction mismatch in which function is sacrificed for survival. If revascularization is performed in a timely fashion, metabolism can be restored leading to recovery of function. Through the use of noninvasive imaging modalities, assessing myocardial viability can be easily performed and will aid in selecting those patients who will benefit from revascularization. Viable myocardium can be identified by nuclear modalities that have a high sensitivity but a lower specificity, such as thallium-201 single photon emission computed tomography and positron emission tomography (PET); or by the use of dobutamine stress echocardiogram (DSE), which has a decreased sensitivity but a better specificity. A modality that is increasingly being used with an overall good sensitivity and specificity is contrast-enhanced magnetic resonance imaging. The purpose of this review is to explore the amount of myocardial viability that is relevant to pursue revascularization, since as myocardial function improves there is a decrease in morbidity and mortality from heart failure and arrhythmias.