How to differentiate the etiology of LV dysfunction as to whether it is “ischemic cardiomyopathy” or “dilated non-ischemic cardiomyopathy”? Invasive coronary and myocardial assessment is the approach of first choice

Ahn, Sung Gyun; Samady, Habib

doi:10.1007/s12350-015-0135-2

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…24 Traditionally, the cause of cardiomyopathy has been determined as ICM or NICM by inference from the presence or absence of obstructive CAD on coronary angiography. 25,26 In the past 2 decades, CMR has made it possible to identify the cause of cardiomyopathy by allowing the characterization of the myocardium directly. [9][10][11] Cardiomyopathies often manifest with distinct patterns of myocardial damage, which can be seen as LGE on CMR and help identify the cause of the cardiomyopathy.…”

Section: Discussionmentioning

confidence: 99%

Nonischemic or Dual Cardiomyopathy in Patients With Coronary Artery Disease

Bawaskar,

Thomas,

Ismail

et al. 2024

Circulation

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Background: Randomized trials in obstructive coronary artery disease (CAD) have largely shown no prognostic benefit from coronary revascularization. While there are several potential reasons for the lack of benefit, an underexplored possible reason is the presence of coincidental non-ischemic cardiomyopathy (NICM). We investigated the prevalence and prognostic significance of NICM in patients with CAD (CAD-NICM). Methods: We conducted a registry study of consecutive patients with obstructive CAD on coronary angiography who underwent contrast-enhanced cardiovascular magnetic resonance imaging (CMR) for the assessment of ventricular function and scar at 4 hospitals from 2004 to 2020. We identified the presence and cause of cardiomyopathy using CMR and coronary angiography data, blinded to clinical outcomes. The primary outcome was a composite of all-cause death or heart failure (HF) hospitalization, and secondary outcomes were all-cause death, HF hospitalization, and cardiovascular death. Results: Among 3,023 patients (median age 66 years, 76% men), 18.2% had no cardiomyopathy (CAD+noCM), 64.8% had ischemic cardiomyopathy (CAD+ICM), 9.3% had CAD+NICM, and 7.7% had dual cardiomyopathy (CAD+dualCM) defined as both ICM and NICM. Thus, 16.9% had CAD+NICM or dualCM. During a median follow-up of 4.8 years (interquartile range, 2.9, 7.6), 1,116 patients experienced the primary outcome. In Cox multivariable analysis, CAD+NICM or dualCM was independently associated with a higher risk of the primary outcome compared with CAD+ICM [adjusted hazard ratio (HR) 1.23; 95% confidence interval (CI) 1.06-1.43; P = 0.007] after adjustment for potential confounders. The risks of the secondary outcomes of all-cause death and HF hospitalization were also higher with CAD+NICM or dualCM (HR 1.21; 95% CI 1.02-1.43; P = 0.032 and HR 1.37; 95% CI 1.11-1.69; P = 0.003 respectively), while the risk of cardiovascular death did not differ from that of CAD+ICM (HR 1.15; 95% CI 0.89-1.48; P = 0.28). Conclusions: In patients with CAD referred for clinical CMR, NICM or dualCM was identified in 1 of every 6 patients and was associated with worse long-term outcomes compared with ICM. In patients with obstructive CAD, coincidental NICM or dualCM may contribute to the lack of prognostic benefit from coronary revascularization.

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Section: Discussionmentioning

confidence: 99%

Nonischemic or Dual Cardiomyopathy in Patients With Coronary Artery Disease

Bawaskar,

Thomas,

Ismail

et al. 2024

Circulation

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“…Drs. Ahn and Samady make the case for comprehensive initial invasive assessment of this patient with a new diagnosis of heart failure, 5 with right and left heart catheterization and coronary angiography, accompanied by consideration of numerous other contemporary invasive physiologic measures involving coronary flow reserve, fractional flow reserve (FFR), high-resolution imaging of coronary plaque and the vascular wall, and then electro-anatomic mapping for assessment of viability.…”

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confidence: 99%