Author + information
- John Hollowed,
- Pooya Banankhah,
- Carmen Flores,
- Mario Roman,
- Grecia Marquez,
- Gracia Viana,
- Juan Sequeira Gross,
- Juani Nieto and
- Ronney Shantouf
Background: American College of Cardiology and American Heart Association guidelines recommend coronary angiography (CA) in all newly diagnosed patients with heart failure with reduced ejection fraction (HFrEF) as a screening method for obstructive coronary artery disease (CAD). This is a class IIa indication with level of evidence C, indicating a lack of significant clinical data. However, there is a paucity of data that looks specifically at patients under the age of 45 with HFrEF. To our knowledge the largest study that investigated patients with HFrEF of unknown etiology who presented without angina found that 31% had significant CAD. The mean age however in that study was 59 years old. We examined a similar patient population of HFrEF without angina under the age of 45 years old.
Methods: All patients with HFrEF of unknown etiology between 2011-2014 were investigated. Inclusion criteria were patients with HFrEF of unknown etiology who underwent CA to investigate CAD as the cause of their cardiomyopathy. Exclusion criteria were HF with LVEF >50%, a known etiology for HF, angina, known CAD and indication for CA for other purposes. Significant CAD was defined as ≥70% luminal narrowing in at least one coronary artery or >50% for the proximal left anterior descending artery.
Results: 45 patients were included over the period of investigation. The primary finding was that only 11.1% of the patients had significant CAD. The mean age was 40 years and the population was predominantly Hispanic (55.6%) and male (86.7%). Regarding underlying cardiovascular risk factors for this population, 44.4% had hypertension, 13.3% diabetes, 53.3% tobacco abuse, and 22.2% dyslipidemia. The degree of left ventricular systolic dysfunction was substantial with a mean LVEF of 39%.
Conclusions: In our population under the age of 45 with HFrEF of unknown etiology, there were a much lower percentage of patients that had significant CAD than previously reported data from the general population. This finding warrants further investigation, as there may be less benefit from invasive evaluation of CAD in this age group than previously believed and the risks of complications from CA may outweigh the benefits of routine screening.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Novel Imaging and Therapies in Heart Failure
Abstract Category: 12. Heart Failure and Cardiomyopathies: Basic
Presentation Number: 1200-258
- 2017 American College of Cardiology Foundation