Coronary Artery Disease prevalence in Heart Failure with Reduced Ejection Fraction

Abstract

Background and Aims: Even though heart failure (HF) is a major global health problem, studies on the prevalence and etiology of HF in Nepal are scant. Coronary artery disease (CAD) has been reported to be the etiology in 18% of HF presentations to the emergency department of a tertiary cardiac center in Nepal1. Present study evaluated the prevalence and characteristics of CAD in HF with reduced ejection fraction (HFrEF) with coronary angiography (CAG).
 Methods: In a prospective, observational study, conducted from June 2018 to May 2019, 95 patients with HFrEF undergoing CAG, at Shahid Gangalal National Heart Centre, were evaluated.
 Results: The mean age of the patients was 62.7±10.1 years, with 67% males. Obstructive CAD was present in 31(33%) with 48%, 39% and 13% having triple (TVD), single (SVD) and double vessel disease (DVD) respectively. Age ≥ 65 years, smokers, dyslipidemia, obesity, angina, indexed left ventricular end diastolic volume (iEDV), indexed LV systolic diameter (iLVIDs) and regional wall motion abnormality (RWMA) on echocardiography were predictors of CAD, among only which, smoking was the independent predictor of CAD.
 Conclusion: Our results suggest a lower prevalence of CAD in HFrEF than previously reported from developed countries, which may be due to a systematic angiography approach and exclusion of previous coronary events. We encourage clinicians to aggressively identify this co-morbidity as it has important treatment and prognostic implementations.

Study to Evaluate Coronary Artery Disease Prevalence and Risk Factors in Heart Failure Patients with Reduced Ejection Fraction

“…13 If taken that also our prevalence of CAD having stenosis >70% was 27% that closely matches with the descriptive studies from Nepal suggesting almost one-third of HFrEF are likely due to obstructive CAD (ischemic). 3,6,7 We further analyzed the forty-five cases with significant CAD (i.e stenosis >50%) for the involvement of coronary arteries where 20 (45%) were having triple vessel disease (TVD), 14 (32%) were having double vessel disease and 11 (23%) were having single vessel disease as shown in Figure 1. Individual assessment of coronary vessels showed involvement of LAD in 25 (55.5%), RCA in 12 (26.6%), and LCX in 8 (17.8%) cases (as in Figure 2).…”

“…7,14,15 One study from central Nepal had shown significant CAD in only 33% of patients. 3 This is because the investigator had taken stenosis >70% as significant. In our study, only 27% of patients had obstructive CAD (stenosis >70%) which and 73% in patients with risk factors of 3 or more) as shown in Figure 3.…”

“…Similar results are seen in other studies too and there are studies where smoking and diabetes are commonly associated with multivessel diseases. 3,12,17 Use of statins primarily also has been proven beneficial in these patients. 20 In clinical practice, systematic CAG is not always possible in all patients admitted for HF, but the potential survival benefit of revascularization justifies the aggressive management of heart failure even in elderly patients with significant VHD like aortic stenosis.…”

“…A recent study done in central Nepal for otherwise unexplained HFrEF showed 33% significant CAD. 3 Studies done outside show CAD accounting for about two-thirds of cases of heart failure with reduced ejection fraction (HFrEF). 4 Demonstration of underlying etiology is the cornerstone of HF diagnosis and virtually all patients with unexplained HF should be evaluated for the presence of CAD.…”