缺血性左心室功能障碍患者经常接受心肌活力测试。历史模型假定,那些功能失调但存活的心肌区域广泛的人可以从血运重建中获得特别的益处。而那些没有广泛生存能力的人没有。这些假设依赖于冬眠理论,并且基于低质量的数据:因此,采取教条式的方法可能会导致患者被拒绝,预后重要的治疗方法。来自一项随机STICH试验的子研究的最新数据挑战了这些历史概念,因为存活心肌的体积无法预测冠状动脉旁路移植术的有效性。如果心脏团队现在放弃生存能力测试,还是在我们解释生存能力的方式中需要新的范式?这份最新的审查严格地审查了生存能力测试的证据基础,特别关注生存能力之间的假设相互作用,功能恢复,血运重建和预后是传统模式的基础。我们考虑生存力是否应该仅与功能失调的心肌有关,还是更广泛地考虑,并在血运重建决策之外探索生存力测试的更广泛用途。最后,我们期待正在进行和未来的随机试验,这将在未来塑造循证临床实践。
Patients with ischaemic left ventricular dysfunction frequently undergo myocardial viability testing. The historical model presumes that those who have extensive areas of dysfunctional-yet-viable myocardium derive particular benefit from revascularization, whilst those without extensive viability do not. These suppositions rely on the theory of hibernation and are based on data of low quality: taking a dogmatic approach may therefore lead to patients being refused appropriate, prognostically important treatment. Recent data from a sub-study of the randomized STICH trial challenges these historical concepts, as the volume of viable myocardium failed to predict the effectiveness of coronary artery bypass grafting. Should the Heart Team now abandon viability testing, or are new paradigms needed in the way we interpret viability? This state-of-the-art review critically examines the evidence base for viability testing, focusing in particular on the presumed interactions between viability, functional recovery, revascularization and prognosis which underly the traditional model. We consider whether viability should relate solely to dysfunctional myocardium or be considered more broadly and explore wider uses of viability testingoutside of revascularization decision-making. Finally, we look forward to ongoing and future randomized trials, which will shape evidence-based clinical practice in the future.