Ischemic cardiomyopathy explained

Specialty:Cardiology
Ischemic Cardiomyopathy
Symptoms:Sudden fatigue
Causes:Atherosclerosis, Vasospasm
Diagnosis:MRI
Treatment:Percutaneous intervention[1]

Ischemic cardiomyopathy is a type of cardiomyopathy caused by a narrowing of the coronary arteries which supply blood to the heart.[2] Typically, patients with ischemic cardiomyopathy have a history of acute myocardial infarction,[3] however, it may occur in patients with coronary artery disease, but without a past history of acute myocardial infarction. This cardiomyopathy is one of the leading causes of sudden cardiac death.[4] The adjective ischemic means characteristic of, or accompanied by, ischemia — local anemia due to mechanical obstruction of the blood supply.[5]

Signs and symptoms

Signs and symptoms of ischemic cardiomyopathy include sudden fatigue, shortness of breath, dizziness, and palpitations.

Cause

Ischemic cardiomyopathy is the cause of more than 60% of all cases of systolic congestive heart failure in most countries of the world.[6] A chest radiograph that demonstrates coronary artery calcification is a probable indication of ischemic cardiomyopathy.[7] The following are causes of ischemic cardiomyopathy:[8]

Pathophysiology

Ischemic cardiomyopathy is caused by too little blood flow and hence oxygen reaching the muscular layer of the heart due to a narrowing of coronary arteries in turn causing cell death. This can cause different levels of tissue injury and affect large and intermediate arteries alike.[9] [10] [11]

Diagnosis

Ischemic cardiomyopathy can be diagnosed via magnetic resonance imaging (MRI) protocol, imaging both global and regional function. Also the Look-Locker technique is used to identify diffuse fibrosis; it is therefore important to be able to determine the extent of the ischemic scar.[12] Some argue that only left main- or proximal-left anterior descending artery disease is relevant to the diagnostic criteria for ischemic cardiomyopathy. Myocardial imaging usually demonstrates left ventricular dilation, severe ventricular dysfunction, and multiple infarctions.[13] Signs include congestive heart failure, angina edema, weight gain and fainting, among others.[14]

Management

Restoring adequate blood flow to the heart muscle in people with heart failure and significant coronary artery disease is strongly associated with improved survival, some research showing up to 75% survival rates over 5 years.[15] [16] A stem cell study indicated that using autologous cardiac stem cells as a regenerative approach for the human heart (after a heart attack) has great potential.[17]

American Heart Association practice guidelines recommend implantable cardioverter-defibrillator (ICD) use in those with ischemic cardiomyopathy (40 days post-MI) that are (NYHA) New York Heart Association functional class I. A LVEF measurement (simply called LVEF alone among cardiologists) of greater than (>) 30% is often used to differentiate primary from ischemic cardiomyopathy, and as a prognostic indicator.[18] [19]

A 2004 study showed the patients in that study who underwent ventricular restoration as well as a coronary artery bypass achieved greater postoperative LVEF than with the latter surgery alone.[20] Severe cases are treated with heart transplantation.[21]

Prognosis

One of the most important features differentiating ischemic cardiomyopathy from the other forms of cardiomyopathy is the shortened, or worsened all-cause mortality in patients with ischemic cardiomyopathy. According to several studies, coronary artery bypass graft surgery has a survival advantage over medical therapy (for ischemic cardiomyopathy) across varied follow-ups.[22] [23] [24]

Further reading

Notes and References

  1. Book: Burke. Allen P.. Tavora. Fabio. Practical Cardiovascular Pathology. 2010. Lippincott Williams & Wilkins. 9781605478418. 96. 2 January 2018. en.
  2. Web site: Cardiomyopathy: MedlinePlus Medical Encyclopedia. www.nlm.nih.gov. 2015-09-09.
  3. Felker. G.Michael. Shaw. Linda K. O’Connor. Christopher M. A standardized definition of ischemic cardiomyopathy for use in clinical research. Journal of the American College of Cardiology. January 2002. 39. 2. 210–218. 10.1016/S0735-1097(01)01738-7. 11788209. free.
  4. Book: Reynolds Delgado. Interventional Treatment of Advanced Ischemic Heart Disease. 21 April 2009. Springer Science & Business Media. 978-1-84800-395-8. 39–.
  5. Web site: Silent Ischemia and Ischemic Heart Disease .
  6. Book: Griffin, Brian P.. Manual of Cardiovascular Medicine. Lippincott Williams & Wilkins. 2012-10-01. 130. 9781451131604.
  7. Book: Fundamentals of Diagnostic Radiology. Lippincott Williams & Wilkins. 2007-01-01. 635. 9780781761352. William E.. Brant. Clyde A.. Helms.
  8. Book: Manual of Heart Failure Management. Springer Science & Business Media. 2009-04-09. 50. 9781848821859. John D.. Bisognano. Marc L.. Baker. Mary Beth. Earley.
  9. Anversa. Piero. Sonnenblick. Edmund H.. Ischemic cardiomyopathy: Pathophysiologic mechanisms. Progress in Cardiovascular Diseases. 33. 1. 1990. 49–70. 0033-0620. 10.1016/0033-0620(90)90039-5. 2142312.
  10. Yatteau. Ronald F.. Peter. Robert H.. Behar. Victor S.. Bartel. Alan G.. Rosati. Robert A.. Kong. Yihong. Ischemic cardiomyopathy: The myopathy of coronary artery disease. The American Journal of Cardiology. 34. 5. 1974. 520–525. 0002-9149. 10.1016/0002-9149(74)90121-0. 4278154.
  11. Book: Mann DL, Zipes DP, Libby P, Bonow RO. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 30 July 2014. Elsevier Health Sciences. 978-0-323-29064-7. 1225–.
  12. Book: Hodler. Jurg. Diseases of the Chest and Heart: Diagnostic Imaging and Interventional. 2015. Springer. 978-88-470-5751-7. 146. 10 September 2015.
  13. Book: E. van der Wall. K.J. Lie. Recent Views on Hypertrophic Cardiomyopathy. 6 December 2012. Springer Science & Business Media. 978-94-009-4994-2. 43–.
  14. Book: Allen P. Burke. Fabio Tavora. Practical Cardiovascular Pathology. 8 November 2010. Lippincott Williams & Wilkins. 978-1-60547-841-8. 96–.
  15. Luciani. Giovanni Battista. Montalbano. Giuseppe. Casali. Gianluca. Mazzucco. Alessandro. Predicting long-term functional results after myocardial revascularization in ischemic cardiomyopathy. The Journal of Thoracic and Cardiovascular Surgery. 120. 3. 2000. 478–489. 0022-5223. 10.1067/mtc.2000.108692. 10962408. free.
  16. Book: Ischemic Heart Disease. CRC Press. 2007-03-28. 226. 9781840765151. Erling. Falk. Prediman. Shah. Pim de. Feyter.
  17. Cardiac regeneration and diabetes. Regenerative Medicine Research. 2014-01-03. 2050-490X. 4422323. 25984329. 2. 1. 1. 10.1186/2050-490X-2-1. Lu. Cai. Bradley B. Keller . free .
  18. Iskandrian. Abdulmassih S.. Helfeld. Hope. Lemlek. Joseph. Lee. Jaetae. Iskandrian. Basil. Heo. Jaekyeong. Differentiation between primary dilated cardiomyopathy and ischemic cardiomyopathy based on right ventricular performance. American Heart Journal. 123. 3. 1992. 768–773. 0002-8703. 10.1016/0002-8703(92)90518-Z. 1539529.
  19. Hunt. S. A.. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): Developed in Collaboration With the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: Endorsed by the Heart Rhythm Society. Circulation. 20 September 2005. 112. 12. 1825–1852. 10.1161/CIRCULATIONAHA.105.167587. free.
  20. Maxey. Thomas S. Reece. T.Brett. Ellman. Peter I. Butler. Paris D. Kern. John A. Tribble. Curtis G. Kron. Irving L. Coronary artery bypass with ventricular restoration is superior to coronary artery bypass alone in people with ischemic cardiomyopathy. The Journal of Thoracic and Cardiovascular Surgery. 127. 2. 2004. 428–434. 0022-5223. 10.1016/j.jtcvs.2003.09.024. 14762351. free.
  21. Louie HW, Laks H, Milgalter E, Drinkwater DC, Hamilton MA, Brunken RC, Stevenson LW . Ischemic cardiomyopathy. Criteria for coronary revascularization and cardiac transplantation . . 84 . 5 Suppl . III290–III295 . November 1991 . 1934422.
  22. O’Connor. Christopher M. Velazquez. Eric J. Gardner. Laura H. Smith. Peter K. Newman. Mark F. Landolfo. Kevin P. Lee. Kerry L. Califf. Robert M. Jones. Robert H. Comparison of coronary artery bypass grafting versus medical therapy on long-term outcome in patients with ischemic cardiomyopathy (a 25-year experience from the Duke Cardiovascular Disease Databank). The American Journal of Cardiology. 90. 2. 2002. 101–107. 0002-9149. 10.1016/S0002-9149(02)02429-3. 12106836.
  23. Long-term Survival of Patients with Ischemic Cardiomyopathy Treated by CABG versus Medical Therapy. The Annals of Thoracic Surgery. 2012-02-01. 0003-4975. 3638256. 22269720. 523–530. 93. 2. 10.1016/j.athoracsur.2011.10.064. Eric J.. Velazquez. Judson B.. Williams. Eric. Yow. Linda K.. Shaw. Kerry L.. Lee. Harry R.. Phillips. Christopher M.. O’Connor. Peter. K.Smith. Robert H.. Jones.
  24. Elefteriades. John A. Morales. David L.S. Gradel. Christophe. Tollis. George. Levi. Evelyn. Zaret. Barry L. Results of Coronary Artery Bypass Grafting by a Single Surgeon Patients With Left Ventricular Ejection Fractions ≤30%. The American Journal of Cardiology. 79. 12. 1997. 1573–1578. 0002-9149. 10.1016/S0002-9149(97)00201-4. 9202343. free.

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