Some current views on chronic ischemic heart disease

Czech version

Authors: J. Vojáček
Authors‘ workplace: I. interní klinika Lékařské fakulty UK a FN Hradec Králové, přednosta prof. MUDr. Jan Vojáček, DrSc., FESC, FACC
Published in: Vnitř Lék 2009; 55(9): 827-831
Category: 80th Birthday - prof. MUDr. Miloš Štejfa, DrSc., FESC

Overview

Chronic myocardial ischemia results from a temporary disbalance between supply of oxygen to myocardium and consumption of oxygen by myocardium. The most frequent cause of ischemic heart disease is atherosclerosis of the coronary arteries. At present, diagnosis of coronary impairment is for practical reasons not possible until myocardial ischemia is detectable. Despite the current pharmacological treatments, data from the recent studies justify stratification of prognosis of patients with chronic ischemic heart disease into subgroups with low, medium and high risk. Mean annual mortality is below 1% in patients with low risk, 1–2% in patients with medium risk and above 2% in patients with high risk. Revascularization procedures might improve prognosis in certain subgroups of patient with chronic ischemic heart disease. Revascularization also decreases the incidence of ischemic episodes and improves the left ventricle function in some subgroups.

Key words:
ischemic heart disease – coronary heart disease – interventional treatment – surgical treatment

Sources

1. Stejfa M Jr, Mocek J, Dvorak I. On “imminent infarction”. Cardiologia 1962; 40: 24–32.

2. Štejfa M Jr. Chronická angina pectoris. Čas Lék Čes 1968; 107: 729–732.

3. Stejfa M. Instable angina pectoris and the pre-infarct condition. Z Gesamte Inn Med 1977; 32: 203–205.

4. Varnauskas E. Twelve-year follow up of survival in the randomized European Coronary Surgery Study. N Engl J Med 1988; 319: 332–337.

5. Myers WO, Schaff HV, Gersh BJ et al. Improved survival of surgically treated patients with triple vessel coronary artery disease and severe angina pectoris. A report from the Coronary Artery Surgery Study (CASS) registry. J Thorac Cardiovasc Surg 1989; 97: 487–495.

6. Yusuf S, Zucker D, Peduzzi P et al. Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet 1994; 344: 563–570.

7. Boden WE, O’Rourke RA, Teo KK et al. COURAGE Trial Research Group. Optimal Medical Therapy with or without PCI for Stable Coronary Disease. N Engl J Med 2007; 356: 1503–1516.

8. Boden WE, O’Rourke RA, Teo KK et al. COURAGE Trial Investigators. Impact of optimal medical therapy with or without percutaneous coronary intervention on long-term cardiovascular end points in patients with stable coronary artery disease (from the COURAGE Trial). Am J Cardiol 2009; 104: 1–4.

9. Fox K, Garcia MA, Ardissino D et al. Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology; ESC Committee for Practice Guidelines (CPG). Guidelines on the management of stable angina pectoris: executive summary: the Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Eur Heart J 2006; 27: 1341–1381.

10. Schinkel AF, Bax JJ, Poldermans D et al. Hibernating myocardium: diagnosis and patient outcome. Curr Probl Cardiol 2007; 32: 375–410.

11. Wiggers H, Noreng M, Paulsen PP et al. Energy stores and metabolites in chronically reversibly and irreversibly dysfunctional myocardium in humans. J Am Coll Cardiol 2001; 37: 100–108.

12. Depre C, Kim SJ, John AS et al. Program of cell survival underlying human and experimental hibernating myocardium. Circ Res 2004; 95: 433–440.

13. Wiggers H, Nielsen SS, Holdgaard P et al. Adaptation of nonrevascularized human hibernating and chronically stunned myocardium to long-term chronic myocardial ischemia. Am J Cardiol 2006; 98: 1574–1580.

14. Bax JJ, Schinkel AF, Boersma E et al. Extensive left ventricular remodeling does not allow viable myocardium to improve in left ventricular ejection fraction after revascularization and is associated with worse long-term prognosis. Circulation 2004; 110 (11 Suppl 1): II18–II22.

15. Allman KC, Shaw LJ, Hachamovitch R et al. Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis. J Am Coll Cardiol 2002; 39: 1151–1158.