From the Guidelines
Ischemic cardiomyopathy is characterized by reduced left ventricular function, heart chamber dilation, and thinning of heart walls in areas damaged by previous infarctions, with an ejection fraction typically below 40%. The primary characteristics of ischemic cardiomyopathy include:
- Reduced left ventricular function with an ejection fraction typically below 40%
- Heart chamber dilation
- Thinning of heart walls in areas damaged by previous infarctions
- Patients often present with symptoms of heart failure such as shortness of breath, fatigue, and fluid retention, as well as angina due to ongoing ischemia
- Diagnostic findings include regional wall motion abnormalities on echocardiography, evidence of coronary artery disease on angiography, and myocardial scarring on cardiac MRI 1 The condition develops when insufficient blood supply causes myocardial damage, leading to remodeling where the heart dilates to maintain cardiac output. This compensation eventually fails, resulting in progressive heart failure. Risk factors mirror those of coronary artery disease, including hypertension, diabetes, smoking, and hyperlipidemia. Treatment typically involves a combination of medications (ACE inhibitors/ARBs, beta-blockers, aldosterone antagonists, and diuretics), revascularization procedures when appropriate, device therapy such as ICDs or CRT for eligible patients, and lifestyle modifications including smoking cessation, dietary changes, and cardiac rehabilitation 1.
From the Research
Definition and Epidemiology
- Ischemic cardiomyopathy (ICM) is defined as left ventricular dysfunction in the presence of significant coronary artery disease 2.
- The prevalence of ICM is influenced by age and sex, with older individuals and males being more affected 2.
- ICM is the most prevalent cause of heart failure (HF) in developed countries, with significant morbidity and mortality 2.
Pathophysiology
- The pathophysiology of ICM is characterized by plaque buildup, thrombus formation, hypoperfusion, ischemic cell death, and left ventricular remodeling 2.
- The extent of coronary artery disease (CAD) is independently associated with shorter survival in patients with symptomatic HF 3.
Clinical Characteristics
- Patients with ICM are older and have more comorbidities compared to those with non-ischemic dilated cardiomyopathy (NIDCM) 4.
- ICM patients are more likely to be treated with statins and antiplatelet agents, while NIDCM patients are more frequently treated with anticoagulants and digitalis 4.
- ECG evidence of Q-wave MI is more common in patients with ICM, while left bundle branch block is less common 5.
Prognosis and Treatment
- The 1-year mortality rate for ICM is 16%, and the 5-year mortality rate is approximately 40% in the USA and Europe 2.
- ICM etiology is an independent predictor of the composite endpoint of all-cause death and readmissions for HF at 12 months 4.
- Therapeutic options for ICM include lifestyle changes, optimal medical therapy, revascularization, device therapy, mechanical circulatory support, and cardiac transplantation 2, 6.
- Personalized management strategies and tailored patient care are needed to improve the outcomes of patients with ICM 2.