PDF(Pubmed)
Abstract：
The concept of myocardial viability is usually referred to areas of the myocardium, which show contractile dysfunction at rest and in which contractility is expected to improve after revascularization. The traditional paradigm states that an improvement in function after revascularization leads to improved health outcomes and that assessment of myocardial viability in patients with ischaemic left ventricular dysfunction (ILVD) is a prerequisite for clinical decisions regarding treatment. A range of retrospective observational studies supported this \'viability hypothesis\'. However, data from prospective trials have diverged from earlier retrospective studies and challenge this hypothesis. Traditional binary viability assessment may oversimplify ILVD\'s complexity and the nuances of revascularization benefits. A conceptual shift from the traditional paradigm centred on the assessment of viability as a dichotomous variable to a more comprehensive approach encompassing a thorough understanding of ILVD\'s complex pathophysiology and the salutary effect of revascularization in the prevention of myocardial infarction and ventricular arrhythmias is required.
摘要：
心肌生存力的概念通常是指心肌的区域，在休息时表现出收缩功能障碍，并且在血运重建后收缩力有望改善。传统范式指出，血运重建后功能的改善可改善健康状况，并且评估缺血性左心室功能障碍（ILVD）患者的心肌活力是临床决定治疗的前提。一系列回顾性观察研究支持了这一“生存力假设”。然而,前瞻性试验的数据与早期的回顾性研究不同,对这一假设提出了挑战.传统的二元可行性评估可能会过度简化ILVD的复杂性和血运重建益处的细微差别。需要从传统范式的概念转变，以评估作为二分变量的生存能力为中心，转变为更全面的方法，包括彻底了解ILVD的复杂病理生理学以及血运重建在预防心肌梗死和室性心律失常中的有益作用。
