Ischemic Cardiomyopathy versus Non-Ischemic Dilated Cardiomyopathy in Patients with Reduced Ejection Fraction— Clinical Characteristics and Prognosis Depending on Heart Failure Etiology (Data from European Society of Cardiology Heart Failure Registries)

Abstract

Personalized management involving heart failure (HF) etiology is crucial for better prognoses for HF patients. This study aimed to compare patients with ischemic cardiomyopathy (ICM) and patients with non-ischemic dilated cardiomyopathy (NIDCM) in terms of baseline characteristics and prognosis. We assessed 895 patients with HF with reduced left ventricular ejection fraction participating in the Polish part of the European Society of Cardiology (ESC)-HF registries. ICM was present in 583 patients (65%), NIDCM in 312 patients (35%). The ICM patients were older (p < 0.001) and had more comorbidities. The NIDCM patients more frequently had atrial fibrillation (p = 0.04) and lower LVEF (p = 0.01); therefore, they were treated more often with anticoagulants (p = 0.01) and digitalis (p < 0.001). The NIDCM patients were prescribed aldosterone antagonists more often (p = 0.01). There were no other differences as regards the use of HF guideline-recommended medications, implantable cardioverter defibrillators or cardiac resynchronization therapy. The ICM patients were more likely to be treated with statins (p < 0.001) and antiplatelet agents (p < 0.001). All-cause death, as well as all-cause death and readmissions for HF at 12 months, occurred more often in the ICM group compared with the NIDCM group (15.9% vs. 10%, p = 0.016; and 40.9% vs. 28.6%, p = 0.00089, respectively). ICM etiology was an independent predictor of the composite endpoint in the total cohort (p = 0.003). The ICM patients were older and had more comorbidities, whereas the NIDCM patients had lower LVEF. One-year prognosis was worse in the ICM patients than in the NIDCM patients. ICM etiology was independently associated with a worse one-year outcome.

Understanding the Heart Failure Evolution as an Important Step toward Optimized Treatment

“…It should be emphasized that up to 1/3 of the patients at the time of inclusion in the study had no symptoms. Globally, changes in NYHA class correlated with changes in LVEF and NT-proBNP irrespective of the HF etiology, but not surprisingly, and in accordance with existing data [3], the evolution of analyzed parameters was highly variable with respect to HF category and etiology, with most favorable trajectories being observed in patients with HFrEF from non-ischemic origin. The changes in HF variables are common during long term and it is important to detect them on time as they guide decisions about the frequency of follow-up, need for repeat cardiac imaging, and additional patients' counseling.…”

Fifteen-Year Differences in Indications for Cardiac Resynchronization Therapy in International Guidelines—Insights from the Heart Failure Registries of the European Society of Cardiology

“…In addition to the clinical efficacy of CRT, its cost-effectiveness has been evaluated in several analyses [ 15 , 16 , 17 , 18 , 19 , 20 ]. After reviewing literature that describes years of experience with CRT, the optimal profile of a patient who could benefit most from CRT can be specified ( Figure 1 ) [ 1 , 3 , 7 , 21 , 22 , 23 , 24 ]. Before evaluating the indications for CRT, the patient should receive optimal treatment of HF according to the current best medical knowledge for at least 3 months (or even 6–9 months) [ 1 , 25 ].…”

Immunosuppressive Therapy of Biopsy-Proven, Virus-Negative, Autoimmune/Immune-Mediated Myocarditis—Focus on Azathioprine: A Review of Existing Evidence and Future Perspectives

“…However, some crucial questions are still waiting for answers about the most appropriate moment to start IT in AI, biopsy-proven, virus-negative myocarditis/inflammatory cardiomyopathy and when to stop it. Despite that the majority of published clinical studies seem to show an overall benefit of IT in the treatment of AI, biopsy-proven, virus-negative myocarditis/inflammatory cardiomyopathy, a targeted therapy has still not been standardized, and there is a need for further controlled, preferably multicentric, clinical studies to provide further data on the efficacy and safety of IT in myocarditis [ 3 , 4 , 56 ]. Currently, a multicentric, double-blind, randomized trial (IMPROVE-MC) on a combined 12-month therapy of AZA with prednisone is ongoing in Poland [ 57 ].…”