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Case Series: Is Minimal Coronary Artery Disease a Prognostic Indicator in Dilated Cardiomyopathy?
Background The aim of this study was to study the prognostic implications of minimal coronary artery disease (CAD) in patients with dilated cardiomyopathy (DCMP) in terms of mortality and hospitalization due to heart failure.
Methods One-hundred sixty-three patients with DCMP were recruited for this study. Out of these, 61.9% (n = 101; 62.4% men) patients were without associated minimal CAD and 38% (n = 62; 66.1% men) with associated minimal CAD (stenosis < 50%), and their risk factor profile was noted. These patients were followed for 30 months, with mortality being the primary endpoint, and hospitalization secondary to cardiac decompensation in the form of heart failure was denoted as the secondary endpoint.
Results In our study, independent significant predictors of CAD were age (p = 0.002), hypertension (p = 0.001), diabetes (p < 0.001), and smoking (p = 0.023). The presence of minimal CAD in DCMP patients as a predictor of mortality was not significant (odds ratio [OR]: 1.69, 95% confidence interval [CI]: 0.62–4.62, p = 0.303); however, it was a significant predictor of hospitalization secondary to cardiac decompensation (OR: 6.78, 95% CI: 2.28–20.13, p = 0.001).
Conclusions Minimal CAD was observed in 38% of DCMP patients. The risk factor profile predicting CAD in DCMP patients was the same as that of the general population. The presence of minimal CAD in DCMP patients was not associated with mortality. However, it was associated with hospitalization secondary to cardiac decompensation in the form of heart failure.
Article published online:
19 January 2022
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- 1 Elliott P, Andersson B, Arbustini E. et al. Classification of the cardiomyopathies: a position statement from the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2008; 29 (02) 270-276
- 2 Maron BJ, Towbin JA, Thiene G. et al; American Heart Association, Council on Clinical Cardiology, Heart Failure and Transplantation Committee, Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups, Council on Epidemiology and Prevention. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation 2006; 113 (14) 1807-1816
- 3 Esser S, Gelbrich G, Brockmeyer N. et al. Prevalence of cardiovascular diseases in HIV-infected outpatients: results from a prospective, multicenter cohort study. Clin Res Cardiol 2013; 102 (03) 203-213
- 4 Angelini A, Boffa GM, Livi U, Barchitta A, Casarotto D, Thiene G. Discordance between pre and post cardiac transplant diagnosis: implications for pre- and postoperative decision making. Cardiovasc Pathol 1999; 8 (01) 17-23
- 5 Bortman G, Sellanes M, Odell DS, Ring WS, Olivari MT. Discrepancy between pre- and post-transplant diagnosis of end-stage dilated cardiomyopathy. Am J Cardiol 1994; 74 (09) 921-924
- 6 Repetto A, Dal Bello B, Pasotti M. et al. Coronary atherosclerosis in end-stage idiopathic dilated cardiomyopathy: an innocent bystander?. Eur Heart J 2005; 26 (15) 1519-1527
- 7 Waller TA, Hiser WL, Capehart JE, Roberts WC. Comparison of clinical and morphologic cardiac findings in patients having cardiac transplantation for ischemic cardiomyopathy, idiopathic dilated cardiomyopathy, and dilated hypertrophic cardiomyopathy. Am J Cardiol 1998; 81 (07) 884-894
- 8 McCrohon JA, Moon JC, Prasad SK. et al. Differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease using gadolinium-enhanced cardiovascular magnetic resonance. Circulation 2003; 108 (01) 54-59
- 9 Hedrich O, Jacob M, Hauptman PJ. Progression of coronary artery disease in non-ischemic dilated cardiomyopathy. Coron Artery Dis 2004; 15 (05) 291-297
- 10 White BM, Mehta R, Binkley PF, Leier CV. Latent development of occlusive coronary atherosclerosis as a cause of decompensation of non-ischemic dilated cardiomyopathy. Cardiology 2009; 112 (01) 69-73
- 11 Adams Jr KF, Dunlap SH, Sueta CA. et al. Relation between gender, etiology and survival in patients with symptomatic heart failure. J Am Coll Cardiol 1996; 28 (07) 1781-1788
- 12 Ghali JK, Krause-Steinrauf HJ, Adams KF. et al. Gender differences in advanced heart failure: insights from the BEST study. J Am Coll Cardiol 2003; 42 (12) 2128-2134
- 13 Remme WJ, Swedberg K. European Society of Cardiology. Comprehensive guidelines for the diagnosis and treatment of chronic heart failure. Task force for the diagnosis and treatment of chronic heart failure of the European Society of Cardiology. Eur J Heart Fail 2002; 4 (01) 11-22
- 14 McMurray JJ, Adamopoulos S, Anker SD. et al; Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology, ESC Committee for Practice Guidelines. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2012; 14 (08) 803-869
- 15 Dickstein K, Cohen-Solal A, Filippatos G. et al; ESC Committee for Practice Guidelines (CPG). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 2008; 29 (19) 2388-2442
- 16 Hunt SA, Abraham WT, Chin MH. et al. 2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 2009; 119 (14) e391-e479
- 17 Wynne J, Braunwald E. The cardiomyopathies and myocarditides. In: Braunwald E, Zipes DP, Libby P. eds. Heart Disease. Philadelphia: Saunders; 2001: 1751-1806
- 18 Bart BA, Shaw LK, McCants Jr CB. et al. Clinical determinants of mortality in patients with angiographically diagnosed ischemic or nonischemic cardiomyopathy. J Am Coll Cardiol 1997; 30 (04) 1002-1008
- 19 Felker GM, Shaw LK, O'Connor CM. A standardized definition of ischemic cardiomyopathy for use in clinical research. J Am Coll Cardiol 2002; 39 (02) 210-218
- 20 Ndrepepa G, Tada T, Fusaro M. et al. Association of coronary atherosclerotic burden with clinical presentation and prognosis in patients with stable and unstable coronary artery disease. Clin Res Cardiol 2012; 101 (12) 1003-1011
- 21 Frankenstein L, Hees H, Taeger T. et al. Clinical characteristics, morbidity, and prognostic value of concomitant coronary artery disease in idiopathic dilated cardiomyopathy. Clin Res Cardiol 2013; 102 (10) 771-780
- 22 Cleland JG, Thygesen K, Uretsky BF. et al; ATLAS investigators. Cardiovascular critical event pathways for the progression of heart failure; a report from the ATLAS study. Eur Heart J 2001; 22 (17) 1601-1612
- 23 Yusuf S, Pepine CJ, Garces C. et al. Effect of enalapril on myocardial infarction and unstable angina in patients with low ejection fractions. Lancet 1992; 340 (8829): 1173-1178
- 24 Cooke GE, Eaton GM, Whitby G. et al. Plasma atherogenic markers in congestive heart failure and posttransplant (heart) patients. J Am Coll Cardiol 2000; 36 (02) 509-516
- 25 Franciosa JA, Wilen M, Ziesche S, Cohn JN. Survival in men with severe chronic left ventricular failure due to either coronary heart disease or idiopathic dilated cardiomyopathy. Am J Cardiol 1983; 51 (05) 831-836
- 26 Kelly TL, Cremo R, Nielsen C, Shabetai R. Prediction of outcome in late-stage cardiomyopathy. Am Heart J 1990; 119 (05) 1111-1121
- 27 Pereira VF, de Carvalho Frimm C, Rodrigues AC, Cúri M. Coronary reserve impairment prevents the improvement of left ventricular dysfunction and adversely affects the long-term outcome of patients with hypertensive dilated cardiomyopathy. J Am Soc Hypertens 2010; 4 (01) 14-21
- 28 de Jong RM, Tio RA, van der Harst P. et al. Ischemic patterns assessed by positron emission tomography predict adverse outcome in patients with idiopathic dilated cardiomyopathy. J Nucl Cardiol 2009; 16 (05) 769-774