Finding the road to recovery: therapeutic and clinical trial implications of dysfunctional viable myocardium in heart failure with reduced ejection fraction

Abstract

This article refers to 'Multidimensional contractile reserve predicts adverse outcome in patients with severe systolic heart failure: a 4-year follow-up study', by I.A. Paraskevaidis et al. and 'The importance of myocardial contractile reserve in predicting response to cardiac resynchronization therapy' by M. Kloosterman et al., published in this issue on pages 846-861 and 862-869.

July 2017 at a glance: clinical assessment, biomarkers, cardiac imaging and treatment

“…Taken together, these two studies show the importance of detecting a contractile reserve of dysfunctional but still viable myocardium in patients with HFrEF. These patients are more likely to respond to treatment and dobutamine echocardiography may be used for patient selection in clinical trials and treatment targeted at cardiac function …”

Expanded algorithm for managing patients with acute decompensated heart failure

“…For example, the CHRISTMAS (Carvedilol Hibernation Reversible Ischaemia Trial, Marker of Success) study demonstrated that patients with HFrEF and viable myocardium determined by SPECT had an increase in EF when treated with carvedilol [9]. There is also a relationship between the level of myocardial viability and the percent of improvement in EF with carvedilol [10, 11]. Lastly, the inpatient setting allows for easier communication between consulting services to optimize comorbidities.…”