Chronic ischemic heart disease

							                                                   Editorial




        Chronic ischemic heart disease
                                              Mario Marzilli
                           Department of Cardiology, University of Pisa, Pisa, Italy

              Correspondence: Mario Marzilli, Dipartimento Cardiotoracico, University of Pisa,
                                    Via Paradisa 2, 56100 Pisa, Italy.
                           Tel: +39 050 996751; e-mail: Marzilli@med.unipi.it


The average annual mortality for patients with chronic        Evidence is accumulating that genetic variability
ischemic heart disease and stable angina is 2–3% –         and altered gene and protein expression contribute
that is, twice that of age-matched controls. Certain       significantly to clinical outcomes in ischemic heart
patients, however, are at much higher risk. This high-     disease. Data from ‘‘omics’’ studies show potential to
risk subgroup includes patients with easily inducible      help in the development of novel, more individua-
ischemia, and patients who have suffered previous          lized, therapeutic approaches in coronary artery
myocardial infarction.                                     disease.
   After many years in which cardiologists mostly             New imaging techniques may help in diagnosing
focused on acute ischemic syndromes, today more            heart failure, its causes, course, and prognosis. Posi-
attention is being paid to chronic ischemic heart dis-     tron emission tomography, by enabling the assess-
ease. Chronic ischemic heart disease is increasingly       ment of myocardial perfusion and metabolism, and
recognized as a very dynamic condition. In addition to     magnetic resonance imaging, allowing the evaluation
overt acute myocardial infarction, which can precipi-      of myocardial necrosis and microvascular damage,
tate at any time in patients with ‘‘stable’’ angina pec-   can predict contractile recovery after revasculari-
toris, clinical and subclinical ischemic events may        zation procedures.
accumulate and, in the long term, generate diverse            Papers in this issue of Heart and Metabolism con-
states of chronic cardiac dysfunction. Repetitive epi-     tribute to a better appreciation of the complexity of
sodes of ischemia, whether stress induced or spon-         chronic ischemic syndromes and a better understand-
taneous, symptomatic or silent, may progressively          ing of the prognostic impact of current therapies,
impair myocardial contractile performance through          stimulating the search for innovative approaches
myocardial stunning or hibernation, and eventually         to the evaluation and treatment of this common
lead to left ventricular remodeling and heart failure.     disorder.




Heart Metab. 2009; 42:3                                                                                         3