扩张型心肌病患者隐匿性冠状动脉疾病的患病率及趋势

Prevalence and trends of occult coronary artery disease in patients with dilated cardiomyopathy.

作者信息

Chandra Sharad, Saraf Sameer, Chaudhary Gaurav, Dwivedi Sudhanshu Kumar, Narain Varun Shanker, Sethi Rishi, Sharma Akhil, Pradhan Akshyaya, Vishwakarma Pravesh, Bhandari Monika

机构信息

Department of Cardiology, King George's Medical University Lucknow, Uttar Pradesh 226003, India.

Department of Cardiology, Uttar Pradesh University of Medical Sciences Uttar Pradesh 206130, India.

出版信息

Am J Cardiovasc Dis. 2020 Dec 15;10(5):557-563. eCollection 2020.

PMID:33489458

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7811921/

Abstract

BACKGROUND

Many patients with dilated cardiomyopathy (DCMP), presenting with only dyspnea, have hidden ischemic etiology. In low-income countries, logistic and financial restraints lead to reduced identification of this ischemic burden. We aimed to assess the role of coronary angiography in patients with cardiomyopathy presenting predominantly dyspnea.

METHODS

This was a single-center, prospective, observational study conducted at a tertiary-care center in North India over the period of one year. The study population consisted of patients with dyspnea (NYHA II and III) and left ventricular dysfunction [i.e., left ventricular ejection fraction (< 40%)] without a prior documented coronary artery disease (CAD). All patients underwent invasive coronary angiography to detect underlying occult CAD.

RESULTS

A total of 209 patients with global left ventricular hypokinesia (LVEF) were enrolled. Almost half of the study population belonged to the 51-60-year-old group. Diabetes mellitus and smoking were most prevalent risk factors observed in 93 (44.5%) and 92 (44.1%) patients, respectively. Abnormal coronaries were detected in 75 (35.9%) patients; 44 (58.7%) and 29 (38.7%) patients had significant and insignificant CAD, respectively. Single-, double-, and triple-vessel disease was observed in 18 (40.9%), 14 (31.8%), and 12 (27.3%) patients, respectively. The mean age (54.08 ± 6.02 years), LVEF (39.83 ± 3.27%), SYNTAX score (17.14 ± 2.21), and left ventricular internal dimensions (4.93 ± 0.44 cm) were all statistically insignificant.

CONCLUSION

Patients with DCMP presenting predominantly with dyspnea and having silent underlying significant CAD may benefit from revascularization if CAD is detected by angiography on time.

摘要

背景

许多仅表现为呼吸困难的扩张型心肌病（DCMP）患者存在隐匿性缺血病因。在低收入国家，后勤和经济限制导致对这种缺血负担的识别减少。我们旨在评估冠状动脉造影在以呼吸困难为主的心肌病患者中的作用。

方法

这是一项在印度北部一家三级医疗中心进行的单中心、前瞻性观察性研究，为期一年。研究人群包括有呼吸困难（纽约心脏协会II级和III级）且左心室功能障碍[即左心室射血分数（<40%）]且既往无冠状动脉疾病（CAD）记录的患者。所有患者均接受有创冠状动脉造影以检测潜在的隐匿性CAD。

结果

共纳入209例全球左心室运动减弱（LVEF）患者。几乎一半的研究人群属于51 - 60岁组。糖尿病和吸烟是最常见的危险因素，分别在93例（44.5%）和92例（44.1%）患者中观察到。75例（35.9%）患者检测到冠状动脉异常；44例（58.7%）和29例（38.7%）患者分别患有显著和不显著的CAD。单支、双支和三支血管病变分别在18例（40.9%）、14例（31.8%）和12例（27.3%）患者中观察到。平均年龄（54.08±6.02岁）、LVEF（39.83±3.27%）、SYNTAX评分（17.14±2.21）和左心室内径（4.93±0.44 cm）在统计学上均无显著差异。