Ischemic cardiomyopathy

Ischemic Cardiomyopathy
Classification and external resources
ICD-10 I25.5

Ischemic cardiomyopathy is a type of cardiomyopathy caused by a narrowing of the coronary arteries which supply blood to the heart.[1] Typically, patients with ischemic cardiomyopathy have a history of acute myocardial infarction,[2] 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.[3][3]

Cause

Atherosclerosis

Ischemic cardiomyopathy is the cause of more than 60% of all systolic heart failures in most countries of the world.[3][4] A chest radiography that demonstrates coronary artery calcification is a probable indication of ischemic cardiomyopathy.[5]

Among the causes for ischemic cardiomyopathy are:[6]

Pathophysiology

Ischemic cardiomyopathy is caused by a lack of oxygen 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.[7][8][9]

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.[10] Some argue that only left main- or proximal-left anterior descending artery disease is relevant to the diagnostic criteria for ischemic cardiomyopathy.[2] Myocardial imaging usually demonstrates left ventricular dilation, severe ventricular disfunction, and multiple infarctions.[11] Signs include congestive heart failure, angina edema, weight gain and fainting, among others.[3][12]

Management

Cardiac-Stem-Cells

Revascularization in patients 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.[13][14] A stem cell study indicated that using autologous cardiac stem cells as a regenerative approach for (after myocardial infarction) the human heart has great potential.[15]

American Heart Association practice guidelines indicate (ICD) implantable cardioverter-defibrillator use in those with ischemic cardiomyopathy (40 days post-MI) that are (NYHA) New York Heart Association functional class I. LVEF of >30% is often used to differentiate primary from ischemic cardiomyopathy, and a prognosis indicator.[16][17] At the same time, patients who undergo ventricular restoration on top of coronary artery bypass show improved postoperative ejection fraction as compared to those treated with only coronary artery bypass surgery.[18] Severe cases are treated with heart transplantation.[19]

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.[8][20][21][22]

References

  1. ↑ "Cardiomyopathy: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2015-09-09.
  2. 1 2 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.
  3. 1 2 3 4 Reynolds Delgado (21 April 2009). Interventional Treatment of Advanced Ischemic Heart Disease. Springer Science & Business Media. pp. 39–. ISBN 978-1-84800-395-8.
  4. ↑ Griffin, Brian P. (2012-10-01). Manual of Cardiovascular Medicine. Lippincott Williams & Wilkins. p. 130. ISBN 9781451131604.
  5. ↑ Brant, William E.; Helms, Clyde A. (2007-01-01). Fundamentals of Diagnostic Radiology. Lippincott Williams & Wilkins. p. 635. ISBN 9780781761352.
  6. ↑ 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.
  7. ↑ 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.
  8. 1 2 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.
  9. ↑ Douglas L. Mann; Douglas P. Zipes; Peter Libby; Robert O. Bonow (30 July 2014). Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. Elsevier Health Sciences. pp. 1225–. ISBN 978-0-323-29064-7. Cite uses deprecated parameter |coauthors= (help)
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ Allen P. Burke; Fabio Tavora (8 November 2010). Practical Cardiovascular Pathology. Lippincott Williams & Wilkins. pp. 96–. ISBN 978-1-60547-841-8.
  13. ↑ 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.
  14. ↑ Falk, Erling; Shah, Prediman; Feyter, Pim de (2007-03-28). Ischemic Heart Disease. CRC Press. p. 226. ISBN 9781840765151.
  15. ↑ Cai, Lu; Keller, Bradley B (2014-01-03). "Cardiac regeneration and diabetes". Regenerative Medicine Research 2 (1). doi:10.1186/2050-490X-2-1. ISSN 2050-490X. PMC 4422323. PMID 25984329.
  16. ↑ 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.
  17. ↑ 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. Retrieved 10 September 2015.
  18. ↑ 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 patients 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.
  19. ↑ H. W. Louie, H. Laks, E. Milgalter, D. C. Jr Drinkwater, M. A. Hamilton, R. C. Brunken & L. W. Stevenson (November 1991). "Ischemic cardiomyopathy. Criteria for coronary revascularization and cardiac transplantation". Circulation 84 (5 Suppl): III290–III295. PMID 1934422.
  20. ↑ 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.
  21. ↑ 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.
  22. ↑ 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.

Further reading

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