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冠心病致左心功能不全又称为缺血性心肌病(ICM),临床上是指因冠状动脉狭窄或堵塞导致的难治性左心室功能不全(LVEF≤35%或40%)。已有研究表明大部分缺血性心肌病患者存在冬眠心肌,经冠状动脉旁路移植手术(CABG)可恢复冬眠心肌的收缩力,一定程度上改善射血分数及心衰症状。一些临床检查方法能评估慢性缺血性心功能不全患者的冬眠心肌范围、指导外科再血管化治疗。近5年的一些研究结果均提示对有冬眠心肌的患者行外科再血管化可以改善患者心肌收缩功能、改善心衰症状。在此,我们对冬眠心肌的主要临床评估方法及其对外科再血管化的临床意义作出综述。
Left ventricular dysfunction, also known as ischemic cardiomyopathy (ICM), is clinically defined as refractory left ventricular dysfunction (LVEF ≤35% or 40%) due to coronary artery stenosis or occlusion. Studies have shown that most patients with ischemic cardiomyopathy have hibernating myocardium. Coronary artery bypass grafting (CABG) can restore the contractile force of hibernating myocardium and improve the ejection fraction and heart failure symptoms to a certain extent. Some clinical tests can assess hibernating myocardium in patients with chronic ischemic heart failure and guide surgical revascularization. Some research results in the past five years suggest that surgical revascularization in patients with hibernating myocardium can improve myocardial contractility and improve heart failure symptoms. Here we review the main clinical assessment of hibernating myocardium and its clinical implications for surgical revascularization.