Ischemic cardiomyopathy

Ischemic cardiomyopathy is a type of cardiomyopathy caused by a narrowing of the coronary arteries which supply blood to the heart.[4] Typically, patients with ischemic cardiomyopathy have a history of acute myocardial infarction,[5] 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.[6] The adjective ischemic means characteristic of, or accompanied by, ischemia — local anemia due to mechanical obstruction of the blood supply.[7]

Ischemic Cardiomyopathy
Atherosclerosis one of the causes of this condition
Pronunciation
  • /ɪˈskiːmɪk/
SpecialtyCardiology
SymptomsSudden fatigue
CausesAtherosclerosis, Vasospasm[1]
Diagnostic methodMRI[2]
TreatmentPercutaneous intervention[3]

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][8] A chest radiograph that demonstrates coronary artery calcification is a probable indication of ischemic cardiomyopathy.[9] The following are causes of ischemic cardiomyopathy:[1]

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.[10][11][12]

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.[2] Some argue that only left main- or proximal-left anterior descending artery disease is relevant to the diagnostic criteria for ischemic cardiomyopathy.[5] 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.[6][14]

Management
Coronary bypass surgery

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.[11][22][23][24]

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

Further reading
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