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A standardized definition of ischemic cardiomyopathy for use in clinical research
G Michael Felker1, Linda K Shaw, Christopher M O'Connor
1Duke Clinical Research Institute, Durham, North Carolina, USA. felke001@onyx.dcri.duke.edu
Insights
More extensive coronary artery disease (CAD) in heart failure (HF) patients is linked to shorter survival. A refined definition classifying single-vessel disease without prior events as non-ischemic improves prognostic accuracy for ischemic cardiomyopathy.
Area of Science:
- Cardiology
- Heart Failure Research
- Coronary Artery Disease
Background:
- Ischemic etiology of heart failure (HF) predicts adverse outcomes.
- A uniform definition for ischemic cardiomyopathy is lacking.
- Prognostic implications of coronary artery disease (CAD) extent in HF require clarification.
Purpose of the Study:
- Evaluate the association between CAD extent and survival in symptomatic HF patients.
- Develop a prognostically powerful clinical definition of ischemic cardiomyopathy.
- Identify the most effective method for classifying CAD extent.
Main Methods:
- Assessed clinical history and coronary anatomy in 1,921 symptomatic HF patients with ejection fraction ≤40% undergoing coronary angiography (1986-1999).
- Compared five classification schemes to define CAD extent.
- Developed and validated a novel definition for ischemic cardiomyopathy.
Main Results:
- Extensive CAD independently correlated with reduced survival.
- A modified number-of-diseased-vessels classification, excluding single-vessel disease without prior MI or revascularization as non-ischemic, showed highest prognostic power.
- The new ischemic cardiomyopathy definition demonstrated superior prognostic ability compared to traditional definitions.
Conclusions:
- Ischemic heart failure (HF) diagnosed via angiography is associated with poorer survival than non-ischemic HF.
- Greater CAD extent independently predicts shorter survival in HF.
- Standardizing the definition of ischemic cardiomyopathy is crucial for clinical research and interpretation.
Objectives:
We sought to evaluate the association between the extent of coronary artery disease (CAD) and survival in patients with symptomatic heart failure (HF) and to create the most prognostically powerful clinical definition of ischemic cardiomyopathy.
Background:
An ischemic etiology of HF is known to be a predictor of adverse outcome; however, there is no uniform definition for ischemic cardiomyopathy.
Methods:
We assessed the clinical history and coronary anatomy of patients with symptomatic HF and ejection fraction < or = 40% undergoing diagnostic coronary angiography between 1986 and 1999 (n = 1,921). Five classification schemes were tested to identify the most prognostically powerful method for defining the extent of CAD and to develop the best definition of ischemic cardiomyopathy for prognostic purposes.
Results:
A more extensive CAD was independently associated with shorter survival. When the various classification schemes were compared, a modified number-of-diseased-vessels classification, in which patients with single-vessel disease and no prior history of revascularization or myocardial infarction (MI) were classified as nonischemic, provided the most prognostic power. A definition of ischemic cardiomyopathy that incorporated this definition had more prognostic power than the traditional definition.
Conclusions:
Angiographically diagnosed ischemic HF is associated with shorter survival than nonischemic HF. A more extensive CAD is independently associated with shorter survival, and patients with single-vessel disease and no history of MI or revascularization should be classified as nonischemic for prognostic purposes. Standardization of the definition of ischemic cardiomyopathy will be useful in the conduct and interpretation of clinical research in HF.