Myocardial revascularization for the treatment of post-ischemic heart failure

Heart failure due to coronary artery disease is a major public health probl em. Medical treatment ameliorates symptoms and prognosis, although mortalit y remains high. Heart failure occurs when a sizeable number of myocytes do not contract This may be due to irreversible myocyte loss (infarct) and/or dysfunctional but viable myocytes (hibernating), which can resume function following coronary artery bypass surgery. The presence of hibernating myoca rdium can be predicted by noninvasive nuclear imaging using both single pho ton (SPECT) and positron emission tomography, and also by stress echocardio graphy. A number of uncontrolled studies have demonstrated a promising role for coronary artery bypass surgery in patients with heart failure in whom a substantial amount of hibernating myocardium is present. These findings, particularly the magnitude of the benefits reported, justify the need for a randomized trial in this patient population. (C) 1999 Lippincott Williams & Wilkins, Inc.