The diagnosis of ischemic cardiomyopathy is not well established. Our objective is to determine predictive variables of coronary disease in unselected patients with ventricular dysfunction. This study is a retrospective cohort study of consecutive patients with left ventricular dysfunction and no known history of ischemic heart disease. We analyse the demographic variables, clinical data, electrocardiogram, and echocardiogram that are associated with the presence of coronary stenosis on coronary angiography. A total of 536 patients with left ventricular dysfunction were studied, with 135 (25.2%) of them having significant coronary lesions. In the multivariate logistic regression analysis, age ≤ 50 years, female gender, and the presence of atrial fibrillation on the electrocardiogram (ECG) were predictors of the absence of coronary lesions. Diabetes, hypercholesterolemia, the existence of Q waves in the ECG, and segmental alterations in contractility in the echocardiogram were predictors of coronary heart disease (C-Statistics 0.771, 95% CI 0.727 to 0.814). The information obtained from the clinical history, the ECG, and the echocardiogram of patients with ventricular dysfunction allows us to select subjects in whom coronary angiography has shown poor performance in diagnosing coronary disease.

Introduction The standard modifiable cardiovascular risk factors (SMuRFs), like diabetes mellitus, hyperlipidemia,hypertension and smoking, are central elements of the well-established European Society of Cardiology SCORE calculator. However, acute coronary syndromes (ACS) in SMuRF-less individuals are not uncommon. Purpose Our study aimed to describe the population with and without SMuRFs attended for an ACS and study prognostic factors associated with mortality. Methods We identified 1347 ACS patients without prior history of cardiovascular disease (ACS, cerebrovascular or peripheral artery disease)attended in our university hospital between 2009 and 2012 and examined the proportion of SMuRF-less patients as well as outcomes.The primary outcome was 5-year all-cause death. Results Overall, the median age was 63 years, 73.4% were male and 52 patients (7%)had no SMuRFs. The most common SMuRF was hypertension (60%), followed by smoking (47%), dyslipidemia (48%) and diabetes mellitus (27%). In patients with and without SMuRFs there were no differences in the proportion of females (27% vs 28%), age (63.7 years [IQR 54–75] vs 62 years [IQR 53–71]), renal failure (4.7% vs 0%, p=0.159), prior heart failure (1.6% vs 1.9%, p=0.590) and pulmonary obstructive disease (11.3% vs 9.6%, p=0.707). SMuRF-less patients had substantially less angina in the previously month (1.9% vs 19.1%, p<0.001), were less treated previously with aspirin (3.9% vs 18.9%, p=0.006), betablockers (5.8% vs 16.6%, p=0.039)and ACEI/ARAII (0% vs 38.1%, p<0.001). Patients with SMuRFs presented significantly more frequently with a NSTEMI (63.1% vs 48.1%) and less frequently with STEMI (32.3% vs 44.2%) or a non-classifiable ACS (2.7% vs 7.7%), compared to those without SMurFS. In patients with and without SMuRFs, there were no significant differences in Killip I class (95.4% vs 98%, p=0.370)and GRACE risk score (105 vs 103, p=0.694). Patients with SMuRFS compared to those without had a higher systolic blood pressure (141 mmHg vs 131 mmHg, p=0,03) and a lower glomerular filtration rate (81.8 ml/min/m2 vs 94 ml/min/m2, p=0.04). There were no differences in those with and without SMuRFs in performance of angiography (83% vs 90%, p=0.160), but SMurF-less patients had lower proportion of multivessel disease (18.6% vs 38.2%, p=0.011), higher tendency to percutaneous angioplasty (70.6% vs 57.8%, p=0.073) or performance of CABG (6.1% vs 1.1%, p=0.028).At 5-year follow up (IQR 3–7),SMuRF-less patients had a lower mortality (11.5% vs 23.4%, p=0.049).On multivariable Cox Regression age, chronic renal failure, glomerular filtration rate and GRACE score were independent predictors of death. Coronary angioplasty was a strong protective risk factor of death.However, being SMuRF-less was not protective against mortality. Conclusion The absence of SMuRFs was not an independent predictor of mortality. Our study highlights the importance of the often-overlooked subgroup of ACS patients with atherosclerosis not predicted by SMuRFs. Funding Acknowledgement Type of funding source: None

Background Patients with heart failure (HF) and reduced ejection fraction (rEF) have a poor prognosis. Nevertheless, in the subgroup of patients with recovered ejection fraction (recEF) prognosis is unknown. Purpose To analyze characteristics and prognosis in patients with HFrEF (initial EF and at one year <40%) and HFrecEF (initial EF <40% and at one year ≥40% with ≥10% absolute improvement from the initial value). Methods Retrospective observational study of outpatients referred to the HF unit within March/2006 and November/2021. Baseline characteristics, ecocardiographic data and follow-up were collected, discerning between patients with HFrEF and HFrecEF. Results A total of 346 patients (76.0% men) were analyzed with a mean of age 66.3 (IQR 57.8–74.4) years, of which 50.6% remained with rEF and 49.4% recEF. Median follow-up was 4.6 (2.8–7.9) years. Both groups had a similar risk profile albeit less prevalence of dyslipidemia in the group with recEF (43.5% vs 56.7%, p=0.015). Ischemic etiology predominated in those with rEF (41.7% vs 25.7%, p=0.002) and enolic in recEF (10.5% vs 3.4%, p=0.009). The incidence of combined event (readmission for HF or death) was lower in HFrecEF (33.6% vs 66.4%, p<0.001), as well as death (33.9% vs 66.1%, p<0.001) and readmission for HF (24.4% vs 75.6%, p<0.001). Prevalence of cardiovascular death was lower in the group with recEF (37.8% vs 61.1%, p=0.021). In the multivariate analysis, rEF was an independent predictor for the combined event (HR 2.17; 95% IC [1.45–3.25], p<0.001), as well as for global mortality and readmission for HF. Conclusion Patients with HFrecEF have a similar risk profile than patients with HFrEF although with better long-term prognosis. Funding Acknowledgement Type of funding sources: None.

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