Rev Med UAS
Vol. 13: No. 3. Julio-Septiembre 2023
ISSN 2007-8013

Panorama actual de la viabilidad miocárdica en la disfunción ventricular isquémica. Perspectiva de un cardiólogo clínico

Current overview of myocardial viability in ischemic ventricular dysfunction. A clinical cardiologist’s perspective

Inzunza-Cervantes Gustavo1,*, Herrera-Gavilanes Juan Ramón1, Padilla-Islas Luis Alejandro1, Velarde-Pérez Daniel1, Zazueta-Armenta Verónica1, Félix- Córdova Josué Abisai1

  1. Instituto Mexicano del Seguro Social, Centro Médico Nacional del Noroeste Hospital de Especialidades No. 2 “Luis Donaldo Colosio Murrieta”, Servicio de Cardiología, Ciudad Obregón, Sonora, México.

*Autor de correspondencia: Dr. Gustavo Inzunza-Cervantes
Blvd. Real del Arco, 220. Fraccionamiento Real del Arco, CP 85150 Ciudad Obregón Sonora.
Teléfono: +52 (66) 7191-9895.
Correo electrónico: gusinzunza@live.com.mx

DOI http://dx.doi.org/10.28960/revmeduas.2007-8013.v13.n3.012

Texto Completo PDF

Recibido: 13 de mayo de 2022, aceptado 19 de abril 2023

RESUMEN
La disfunción ventricular isquémica secundaria a enfermedad arterial coronaria es un reto clínico frecuente y controversial, durante las últimas décadas sus diferentes estrategias diagnósticas, pronosticas y terapéuticas se han sustentado en el concepto de miocardio disfuncional pero potencialmente viable. La presente revisión proporciona una descripción general e integrada del conocimiento actual de esta patología cardiovascular. La evaluación de la viabilidad miocárdica en la disfunción ventricular isquémica presenta un nivel de evidencia controversial e inconsistente llevando a una falta de consenso, la evidencia actual de diferentes ensayos clínicos no evidencia beneficio de su uso rutinario como guía para determinar la necesidad de revascularización coronaria, cuestionando su papel como factor decisivo para seleccionar la mejor terapia o justificar la idoneidad de un procedimiento invasivo. Siendo el mejor escenario equilibrar el contexto clínico, la presencia de isquemia, estudios de imagen y los riesgos de revascularización.
Palabras clave: Disfunción miocárdica isquémica, viabilidad, revascularización coronaria, tratamiento médico óptimo

ABSTRACT
Ischemic ventricular dysfunction secondary to coronary artery disease is a frequent and controversial clinical challenge, during the last decades its different diagnostic, prognostic and therapeutic strategies have been based on the concept of dysfunctional but potentially viable myocardium. The present review provides a general and integrated description of the current knowledge of this cardiovascular pathology. The evaluation of myocardial viability in ischemic ventricular dysfunction presents a level of controversial and inconsistent evidence leading to a lack of consensus, current evidence from different clinical trials does not show benefit from their routine use as a guide to determine the need for coronary revascularization, questioning its role as a decisive factor in selecting the best therapy or justifying the suitability of an invasive procedure. Being the best scenario to balance the clinical context, the presence of ischemia, imaging studies and the risks of revascularization.
Key words: Ischemic myocardial dysfunction, viability, coronary revascularization, optimal medical treatment.

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