Echocardiographic Assessment of Patient with Ischemic versus non-ischemic Dilated Cardiomyopathy (original) (raw)
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Ischemic Versus Nonischemic Dilated Cardiomyopathy
ASAIO Journal, 2013
The effect of heart failure etiology on outcomes after left ventricular assist device (LVAD) implantation has not been fully investigated. The aim of this study was to compare postoperative survival, incidence of LVAD-related complications, left and right heart catheterizations, and echocardiographic findings in patients with ischemic cardiomyopathy (ICM) and nonischemic dilated cardiomyopathy (NIDCM) who underwent continuous-flow LVAD implantation. A total of 100 patients underwent implantation of a HeartMate II (Thoratec Corp., Pleasanton, CA) or HeartWare (HeartWare Inc., Framingham, MA) LVAD at our institution. Patients were stratified into two groups based on the etiology of heart failure, ICM and NIDCM. We identified 34 (34.0%) patients with ICM and 66 (66.0%) with NIDCM. Patients with ICM were significantly older (59.5 vs. 49.3; p < 0.001) and had higher rates of hypertension (91.2% vs. 84.8%; p = 0.021), chronic renal insufficiency (38.2% vs. 25.8%; p < 0.001), peripheral vascular disease (11.8% vs. 10.6%; p = 0.015), and previous cardiac surgery (58.8% vs. 13.6%; p < 0.001). Survival was similar for both groups with 30 day, 6 month, and 1 year survivals of 94.1%, 85.3%, and 82.4%, respectively, for ICM patients versus 95.5%, 92.4%, and 89.4%, respectively, for NIDCM patients (p = 0.743). Etiology of heart failure was not an independent predictor of survival in multivariate logistic regression analysis (p = 0.505). Post-LVAD complications and improvements in postoperative hemodynamic measurements were also similar for both groups. The etiology of heart failure did not appear to affect postoperative outcomes significantly
Differences in management and outcome of ischemic and non-ischemic cardiomyopathy
International Journal of Cardiology, 2008
Background: Ischemic and non-ischemic cardiomyopathy (ICM and NICM) both cause heart failure, but the different etiologies may result in differences in management and outcome, which were explored in this study. Methods: Cohort study of 168 consecutive patients (90 ICM, 78 NICM) recruited from a tertiary referral heart failure clinic followed for 40 ± 19 months. Results: Patients with ICM were older than NICM with worse NYHA functional state but similar left ventricular ejection fraction (LVEF) and dimensions at baseline. Similar proportions (N80%) in both groups were on a beta-blocker and angiotensin-converting-enzyme inhibitor and/ or angiotensin-II-receptor blocker (ACE inhibitor ± ARB) by end of study. Mean LVEF improved in both groups over time (27.3 ± 11.9% vs. 33.1 ± 12.6%, p b 0.05). Overall 40-month mortality was 17%. In univariate analysis of patients b80 years old, ICM, NYHA class, serum creatinine, ACE inhibitor ± ARB, and amiodarone use were predictors of mortality, but only serum creatinine was significant in multivariate analysis, with a 2.9-fold relative risk of death (95%CI, 1.34-6.42, p b 0.01) for creatinine ≥ 120 μmol/L compared to b 120 μmol/L. Conclusions: Mortality of patients with cardiomyopathy remains high and is strongly related to serum creatinine. NICM patients were younger and showed greater improvement in symptoms and left ventricular function in long-term follow-up. Crown
Ischemic and non-ischemic dilated Cardiomyopathy
Central European Journal of Medicine, 2014
Dilated Cardiomyopathy is a high-incident disease, which diagnosis of and treatments are clinical priority. The aim of our study was to evaluate the diagnostic potential of cardiac magnetic resonance (CMR) imaging; echocardiography and the biochemical parameters that can help us differentiate between the post-ischemic and non-ischemic dilated cardiomyopathy. Materials and methods. The study enrolled 134 patients with dilated cardiomyopathy: 74 with the post-ischemic form and 60 with the non-ischemic one. All patients underwent a coronary imaging test, with echocardiogram, cardiac magnetic resonance and a blood test. Pro-inflammatory cytokines were evaluated using Luminex kit. Data was compared between the two groups. Results. Echocardiography allowed recognition of Left Ventricular Non Compaction in 2 patients. Longitudinal and circumferential strains were significantly different in the two groups (p<0.05). Using CMR imaging a post-myocarditis scar was diagnosed in 2 patients and a post-ischemic scar in 95% of patients with the chronic ischemic disease. The interleukin IL-1, IL-6 and TNF-α levels were higher in the post-ischemic group compared with the non-ischemic one. Conclusions. The use of second level techniques with a high sensitivity and specificity would help distinguish among different sub-forms of dilated cardiomyopathy.
The open cardiovascular medicine journal, 2012
We explored the differences in epidemiologic, clinical, laboratory and echocardiographic characteristics between idiopathic dilated (IDCM) and ischaemic cardiomyopathy (ICM).Consecutive patients with stable chronic heart failure evaluated at a tertiary cardiac centre were enrolled. Clinical examination, blood tests and echocardiographic study were performed. A total of 76 patients (43 IDCM, 33 ICM) were studied. IDCM patients were younger (p<0.001) and female gender was more prevalent (p=0.022). NYHA class and left ventricular ejection fraction were similar. IDCM patients had lower rates of dyslipidaemia (p<0.001) but smoked more than ICM patients (p=0.023) and had higher rates of family history of sudden cardiac death (p=0.048). Blood pressure was similar but resting heart rate was higher in IDCM patients (p=0.022). IDCM patients presented less frequently with peripheral oedema or ascites (p=0.046 and 0.020, respectively) and showed better right ventricular function on echoca...
A Study to assess clinical and echocardiographic profile of patients with dilated cardiomyopathy
Journal of Medical Science And clinical Research
Introduction: Cardiomyopathy is a primarily disorder of the heart muscle that causes abnormal myocardial performance and is not the result of disease or dysfunction of other cardiac structures.It is an important cause of heart failure and accounts for up to 25% of all cases of heart failure. Materials and Methods: A total 50 patients who were admitted at tertiary care teaching institute of North India and fulfilled inclusion criteria were evaluated by history, clinical examination, Electrocardiograph (ECG) and Echocardiography. Results: Majority of the patients were above the age of 60 years of which males comprised 56% and females comprised 44%. The clinical profile of patients included signs and symptoms of biventricular failure (80%) followed by left ventricular failure (16%). Echocardiography showed reduced ejection fraction and Global hypokinesia and dilatation of all four chambers were seen in all the patients. The most common type of DCM was ischemic comprising of 33% of all cardiomyopathies followed by diabetic cardiomyopathy (24%) and peripartum cardiomyopathy (18%).Idiopathic DCM was seen in 14% of cases. While alcoholic cardiomyopathy seen in 6%.Miscellaneous group included 6% of cases. Abnormalties of pulse rate rhythm included ectopic beats (53%), tachycardia (46%),atrial fibrillation (13%) and brady cardia(3%). Chest x-ray, PA view showed cardiomegaly in all the cases while some patients had plueral effusion (20%). Electrocardiograhic profile revealed ventricular ectopics (46%),sinus tachycardia(40%),Left bundle branch block, LBBB,(40%),right bundle branch block, RBBB, non specific ST-T changes(26%) and atrial fibrillation(13.3%).Echocardiography showed reduced ejection fraction and global hypokinesia in all the patients Conclusion: Dilated cardiomyopathy is common and an important cause of heart failure in the elderly and middle aged population and the etiology varies with age. Biventricular failure was the most common clinical presentation(80%) followed by left ventricular failure(16%) and then right heart failure(3%).The most common type was Ischaemic.
Echo research and practice, 2017
Heart failure (HF) is a debilitating and life-threatening condition, with 5-year survival rate lower than breast or prostate cancer. It is the leading cause of hospital admission in over 65s, and these admissions are projected to rise by more than 50% over the next 25 years. Transthoracic echocardiography (TTE) is the first-line step in diagnosis in acute and chronic HF and provides immediate information on chamber volumes, ventricular systolic and diastolic function, wall thickness, valve function and the presence of pericardial effusion, while contributing to information on aetiology. Dilated cardiomyopathy (DCM) is the third most common cause of HF and is the most common cardiomyopathy. It is defined by the presence of left ventricular dilatation and left ventricular systolic dysfunction in the absence of abnormal loading conditions (hypertension and valve disease) or coronary artery disease sufficient to cause global systolic impairment. This document provides a practical approa...
Ischemic Cardiomyopathy: Contemporary Clinical Management
Current Perspectives on Cardiomyopathies, 2018
Ischemic cardiomyopathy, disease of the heart muscle due to coronary artery disease, is the most common cardiomyopathy. It is often difficult to discern the etiology of heart failure, and often there are multiple underlying causes. Ischemic cardiomyopathy most often presents with a dilated morphology with wall motion defects and a history of previous myocardial infarction or confirmed coronary artery disease. Mechanisms of myocardial depression in ischemia are necrosis of myocardial cells resulting in irreversible loss of function or reversible damage, either short term through myocardial stunning or long term through hibernation. In ischemic cardiomyopathy, echocardiography may be extended with stress testing or other imaging modalities such as myocardial scintigraphy and cardiac magnetic resonance tomography. Coronary angiography is often considered a gold standard; however, other modalities such as positron emission tomography can be needed to detect small vessel disease. Cardiac revascularization, through percutaneous coronary intervention and coronary artery bypass grafting, both in acute coronary syndrome and in stable coronary artery disease, relieves symptoms and improves prognosis. Therapy should aspire to treat ischemia, arrhythmias in addition to heart failure management, which includes device therapy with cardiac resynchronization therapy, implantable cardioverter defibrillators, and mechanical support as bridging or destination therapy in end-stage disease.
Journal of the American College of Cardiology, 2011
The purpose of this study was to determine the prevalence and prognostic role of left ventricular reverse remodeling (LVRR) in idiopathic dilated cardiomyopathy (IDCM). Background Tailored medical therapy can lead to LVRR in IDCM. The prevalence and prognostic impact of LVRR remain unclear. Methods We consecutively enrolled 361 IDCM patients. LVRR was defined as a left ventricular ejection fraction increase of Ն10 U or a left ventricular ejection fraction of Ն50% and a decrease in indexed left ventricular end-diastolic diameter of Ն10% or indexed left ventricular end-diastolic diameter of Ն33 mm/m 2 at 24 months (range 9 to 36 months). Follow-up echocardiographic data were available for 242 patients (67%), 34 (9%) died/underwent heart transplantation (HTx) before re-evaluation, and 85 (24%) did not have a complete re-evaluation. After re-evaluation, the surviving patients were followed for 110 Ϯ 53 months; there were 55 deaths (23%) and 32 HTx (13%). Results LVRR was found in 89 of 242 patients (37%). Baseline predictors of LVRR were higher systolic blood pressure (p ϭ 0.047) and the absence of left bundle branch block (p ϭ 0.009). When added to a prognostic baseline model including male sex, heart failure duration, New York Heart Association functional classes III to IV, LVEF, significant mitral regurgitation, and beta-blockers, LVRR, New York Heart Association functional classes III to IV, and significant mitral regurgitation after 24 months emerged as independent predictors of death/HTx and heart failure death/HTx. The model including follow-up variables showed additional prognostic power with respect to baseline model (for death/HTx, area under the curve: 0.80 vs. 0.70, respectively, p ϭ 0.004). Furthermore, only LVRR was significantly associated with sudden death/major ventricular arrhythmia in the long-term. Conclusions LVRR characterized approximately one-third of IDCM patients surviving 2 years while receiving optimal medical therapy and allowed a more accurate long-term prognostic stratification of the disease.