Heart failure with reduced ejection fraction: Should we submit patients without angina to coronary angiography?

Silva, Filipa; Borges, Tiago; Ribeiro, Ana Freitas; Mesquita, R. M.; Laszczyńska, Olga; Magalhães, Diogo; Silva, João Carlos; Azevedo, Ana; Bettencourt, Paulo

doi:10.1016/j.ijcard.2015.04.115

Cited by 11 publications

(5 citation statements)

References 12 publications

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“…In our study, the combination of clinical variables, the ECG, the echocardiograph, and laboratory tests allowed for a reasonable estimate of the probability of coronary disease in patients with ventricular dysfunction and, more importantly, could suggest to a clinician that the use of this invasive diagnostic technique should be avoided in a notorious proportion of patients. Other studies, based on a very small series of patients, have tried to identify predictors of coronary disease in left systolic ventricular dysfunction [13][14][15]. Thus, Smilowitz, analysing a series of patients much more limited than ours, observed that age, hypertension, diabetes, smoking, the presence of Q waves in the ECG, and abnormalities in the T wave or the ST segment were variables that allowed for estimating the presence of coronary heart disease in a predictive model [4].…”

Section: Discussionmentioning

confidence: 73%

Performance of Coronary Angiography in the Detection of Coronary Artery Disease in Patients with Systolic Left Ventricular Dysfunction and No Prior Ischemic Heart Disease

Peiró

Ferrero

Romeu

et al. 2022

JCM

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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.

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Section: Discussionmentioning

confidence: 73%

Performance of Coronary Angiography in the Detection of Coronary Artery Disease in Patients with Systolic Left Ventricular Dysfunction and No Prior Ischemic Heart Disease

Peiró

Ferrero

Romeu

et al. 2022

JCM

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“…The reported prevalence of obstructive CAD in patients with HFrEF is heterogeneous, with data from randomized clinical trials suggesting obstructive CAD as the underlying cause of HFrEF in nearly 65% of patients, while observational data from studies including HFrEF patients without previous MI or angina suggest a much lower prevalence. 11 In this study we developed a score that estimates the risk of obstructive CAD in patients presenting with new-onset HFrEF of unknown etiology. Two important aspects of the risk prediction model were assessed: discrimination (the ability to identify those who have obstructive CAD) and calibration (reflecting how close predicted obstructive CAD rates are to the actual observed rates).…”

Section: Discussionmentioning

confidence: 99%

Predicting obstructive coronary artery disease in heart failure with reduced ejection fraction: A practical clinical score

Albuquerque

Oliveira

Gonçalves

et al. 2023

Revista Portuguesa de Cardiologia

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“…In the retrospective study by Silva et al, 168 patients were followed in the heart failure clinic, and one-third of the patients without any prior cardiac events or angina had CAD as the etiology of their newly diagnosed HF, which was proven angiographically [19]. There is wide variation in the evaluation of patients that are appropriate for ICA (invasive coronary angiography), with rates of appropriateness as high as 55% [20].…”

Section: Discussionmentioning

confidence: 99%

Ischemic Cardiomyopathy Evaluation with Coronary Calcium Score and CT Angiogram

et al. 2023

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Our study aimed to examine the prevalence of atherosclerotic burden in a predominantly non-white cohort of patients from LA County who underwent coronary artery calcium scoring (CACS) and coronary CT angiogram (CCTA) for the evaluation of cardiomyopathy of ischemic origin. Ischemic cardiomyopathy, primarily caused by reduced blood supply to the heart, is the most common type of cardiomyopathy. CCTA is a well-established and non-invasive imaging test used to assess the extent of coronary artery disease (CAD) in individuals suspected of having it. We analyzed data from 131 patients with cardiomyopathy who were referred to Harbor-UCLA Medical Center between August 2016 and September 2020. These patients had no chest pain, no q waves on electrocardiogram (ECG), and exhibited cardiomyopathy with reduced ejection fraction (EF) without wall motion abnormalities on transthoracic echocardiogram. Among the 131 patients included in our study, the average age was 54.6 years, with 93 (71%) being male. The racial distribution was as follows: 71 (54%) Hispanic, 17 (13%) White, 24 (18%) African American, and 10 (8%) Asian. Various risk factors for coronary artery disease were present, including diabetes mellitus (30%), hypertension (75%), hyperlipidemia (45%), and smoking (46%). We assessed CACS using the Agatston score, while atherosclerotic disease burden was evaluated using total plaque score (TPS), total segment stenosis score (TSSS), and segment involvement score (SIS). Of the patients, 55 (42%) had a CACS of zero, 28 (21%) had a CACS below 10, and the median (interquartile range) of TPS was 1 (1, 5). The median TSSS and SIS were both 1 (1, 5) and 0 (1, 4), respectively. A total of 23 patients (18%) exhibited 50% stenosis indicative of obstructive CAD, while 13 patients (10%) had even more severe stenosis of 75% or greater. Our findings revealed that the majority of patients in our cohort had non-obstructive CAD, suggesting that non-ischemic factors were the primary cause of their cardiomyopathy. Additionally, our study demonstrated that CCTA is an effective non-invasive diagnostic tool for cardiomyopathy, allowing for the avoidance of more invasive procedures in a predominantly non-white population receiving care at a public hospital in LA County.

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Heart failure with reduced ejection fraction: Should we submit patients without angina to coronary angiography?

Cited by 11 publications

References 12 publications

Performance of Coronary Angiography in the Detection of Coronary Artery Disease in Patients with Systolic Left Ventricular Dysfunction and No Prior Ischemic Heart Disease

Performance of Coronary Angiography in the Detection of Coronary Artery Disease in Patients with Systolic Left Ventricular Dysfunction and No Prior Ischemic Heart Disease

Predicting obstructive coronary artery disease in heart failure with reduced ejection fraction: A practical clinical score

Ischemic Cardiomyopathy Evaluation with Coronary Calcium Score and CT Angiogram

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