From the Guidelines
Recent ischemic cardiomyopathy is defined as heart muscle dysfunction with a reduced left ventricular ejection fraction, typically less than 40%, occurring within weeks to months after a myocardial infarction or significant coronary ischemia. This condition is characterized by impaired heart function due to reduced blood flow to the heart muscle (myocardium) caused by coronary artery disease 1. The management of recent ischemic cardiomyopathy involves a multifaceted approach, including:
- Medications such as ACE inhibitors or ARBs, beta-blockers, aldosterone antagonists, and diuretics to improve heart function and reduce symptoms 1
- Revascularization procedures like coronary angioplasty, stenting, or bypass surgery to restore blood flow to the heart muscle 1
- Lifestyle modifications, including sodium restriction, fluid management, regular physical activity as tolerated, and smoking cessation, to reduce the risk of progression to irreversible heart failure 1 It is essential to note that the use of ACE inhibitors or ARBs, such as lisinopril 10-40 mg daily or valsartan 40-160 mg twice daily, is recommended to prevent symptomatic heart failure in patients with a history of myocardial infarction and reduced ejection fraction 1. Additionally, evidence-based beta blockers, such as carvedilol 3.125-25 mg twice daily or metoprolol succinate 25-200 mg daily, should be used to prevent heart failure in patients with a history of myocardial infarction and reduced ejection fraction 1. The goal of treatment is to improve morbidity, mortality, and quality of life by restoring blood flow, reducing symptoms, and preventing progression to irreversible heart failure.
From the Research
Definition of Ischemic Cardiomyopathy
- Ischemic cardiomyopathy (ICM) is defined as a left ventricular dysfunction in the presence of significant coronary artery disease 2, 3.
- It is characterized by systolic left ventricular dysfunction in the setting of obstructive coronary artery disease 3.
- The term "ischemic cardiomyopathy" was initially used to describe a clinical syndrome indistinguishable from primary congestive cardiomyopathy but due to severe, diffuse coronary artery disease 4.
Key Features
- ICM is the most prevalent cause of heart failure (HF) in developed countries, with significant morbidity and mortality 2.
- The prevalence of ICM is largely influenced by age and sex, with older individuals and males being more affected 2.
- The pathophysiology of ICM is characterized by plaque buildup, thrombus formation, hypoperfusion, ischemic cell death, and left ventricular remodeling 2.
Diagnostic Considerations
- A standardized definition of ischemic cardiomyopathy for use in clinical research has been proposed, which incorporates the extent of coronary artery disease and survival in patients with symptomatic heart failure 5.
- Noninvasive functional or anatomic imaging for myocardial ischemia is recommended as the initial test to diagnose coronary artery disease in symptomatic patients 6.