New perspectives on heart failure due to myocardial ischaemia.

Heart failure is a leading cause of morbidity and mortality in the community. Despite improvements in the treatment of heart failure in recent years, for example the use of angiotensin converting enzyme (ACE) inhibitor therapy, morbidity, mortality and resource consumption remain high. In the U.K. heart failure absorbs 1% of the National Health Service budget Current evidence from developed countries suggests ischaemic heart disease is the dominant aetiological factor in the increasing burden of heart failure. Recent work has demonstrated that myocardial dysfunction due to ischaemia is a dynamic and, at least in part, a reversible process. Techniques to detect potential reversibility in individual patients, combined with treatment directed against the ischaemia rather than the contractile dysfunction may provide new approaches to the management of this syndrome.