Clinical review for general practice

Ischemic cardiomyopathy (ICM) is one of the most clinically significant manifestations of chronic coronary artery disease, characterized by progressive left ventricular dysfunction, myocardial remodeling, and a high risk of sudden cardiac death. This article presents a structured review of the current state of diagnosis and treatment of ICM, based on the results of key randomized controlled trials, meta-analyses, and the latest clinical guidelines. The pathophysiological foundations of ICM are discussed, including the roles of myocardial hibernation, stunning, and fibrosis in the clinical presentation, as well as the key mechanisms of neurohormonal and inflammatory dysregulation.The core of therapy lies in an individualized approach to guideline-directed medical therapy (GDMT), which includes β-blockers, renin-angiotensin-aldosterone system (RAAS) inhibitors, mineralocorticoid receptor antagonists, and SGLT-2 inhibitors. The article examines indications and limitations of modern revascularization strategies, including coronary artery bypass grafting (CABG), percutaneous coronary interventions (PCI), and the assessment of myocardial viability. The effectiveness of device-based therapies – implantable cardioverter-defibrillators (ICDs), cardiac resynchronization therapy (CRT), and emerging pacing techniques – is also analyzed. Special attention is given to existing gaps in the evidence base and to future directions, including the integration of artificial intelligence and precision medicine into ICM management strategies. This work emphasizes the importance of a multidisciplinary, prognosis-oriented approach in an era of rapidly evolving cardiology technologies and an expanding therapeutic landscape.