Prognosis of Coronary Atherosclerotic Burden in Non-Ischemic Dilated Cardiomyopathies

Abstract

Background: Atherosclerosis is associated with a worse prognosis in many diseases such as ischemic cardiomyopathy, but its impact in non-ischemic dilated cardiomyopathy (dCMP) is lesser known. Our aim was to study the prognostic impact of coronary atherosclerotic burden (CAB) in patients with dCMP. Methods: Consecutive patients with dCMP and left ventricular (LV) dysfunction diagnosed by concomitant analysis of invasive coronary angiography (ICA) and CMR imaging were identified from registry-database. CAB was measured by Gensini score. The primary composite endpoint was the occurrence of major adverse cardiovascular events (MACE) defined as cardiovascular (CV) mortality, non-fatal MI and unplanned myocardial revascularization. The results of 139 patients constituting the prospective study population (mean age 59.4 ± 14.7 years old, 74% male), average LV ejection fraction was 31.1 ± 11.02%, median Gensini score was 0 (0–3), and mid-wall late gadolinium enhancement (LGE) was the most frequent LGE pattern (42%). Over a median follow-up of 2.8 years, 9% of patients presented MACE. Patients with MACE had significantly higher CAB compared to those who were free of events (0 (0–3) vs. 3.75 (2–15), p < 0.0001). CAB remained the significant predictor of MACE on multivariate logistic analysis (OR: 1.12, CI: 1.01–1.23, p = 0.02). Conclusion: High CAB may be a new prognostic factor in dCMP patients.

Characteristics of the Phenotype of Mixed Cardiomyopathy in Patients with Implantable Cardioverter-Defibrillators

“…Also, scoring of the extent of CAD and its burden with indices or variables like focal or diffuse involvement and location is likely to throw more light into the incremental effect of each variable on the perfusion abnormality. 3,7 Finally, though this is the first study to address the phenotype of mixed CMP in patients implanted with defibrillators, a larger sample size could have established statistical significance to the observed higher trends of mortality in mixed CMP compared to NICM.…”

“…13,14 This finding is also consistent with the studies on idiopathic DCM with coexisting CAD. [6][7][8] While the proportion of device therapies and device shocks in mixed CMP falls in an intermediate category between ICM and NICM, the recorded minimum VT cycle length is comparable to patients with ICM. In a very recent study, albeit in a small cohort of 24 patients with mixed CMP undergoing catheter ablation for ventricular arrhythmias, it was shown that this subset had a higher incidence of ventricular arrhythmias and all-cause mortality than both ICM and NICM.…”

“…In a study on idiopathic DCM patients, CAD burden had significant correlation with major adverse cardiovascular events. 7 Yet another large-scale study in over 12,000 heart failure patients had also shown that the prognosis in nonobstructive CAD (<70% stenosis) is worse than in heart failure with no CAD. 8 However, a few other studies did not show differences in survival between idiopathic DCM with moderate CAD and no CAD.…”

“…9,18,19 Such mixed pathological substrates have also been documented in small-scale studies with LGE-CMRi as well as with perfusion-CMRi. 7,20 While these can be plausible explanations for the bad prognosis in mixed CMP, there could be several other contributing factors as well like age and coexisting illnesses.…”

“…5 The studies on prognosis of concomitant CAD in dilated cardiomyopathies (DCM) are few and these studies have reported the prognosis of the association of CAD in only idiopathic DCM. [6][7][8] Thus, the effect of moderate CAD coexisting with DCM with definite non-ischemic triggers is largely unexplored. The resultant phenotype of 'mixed cardiomyopathy' might identify clinical and outcome characteristics that are distinct from ICM or NICM and may impact on clinical management.…”