Reverse Remodeling After Myocardial Revascularization in Severe Ischemic Heart Disease

Introduction

Heart failure with reduced ejection fraction (HFrEF), especially of ischemic etiology, is a challenging condition associated with high morbidity and mortality.¹ Patients with HFrEF frequently present with ventricular remodeling and progressive systolic dysfunction, making early identification of significant coronary artery disease (CAD) essential for defining therapy and optimizing prognosis.

Triple-vessel CAD involving the left main coronary artery (LMCA) constitutes a high-risk scenario. Guidelines recommend surgical revascularization in most cases, particularly in the presence of pronounced left ventricular dysfunction.² Evidence from studies such as STICH/STICHES has demonstrated that coronary artery bypass grafting (CABG) combined with optimized medical therapy in patients with ischemic cardiomyopathy and reduced left ventricular ejection fraction (LVEF) promotes improved long-term outcomes, although the perioperative risk remains high, with mortality up to 8.6% in patients with LVEF < 35%.³

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