CLINICAL STUDY: HEART FAILURE
A standardized definition of ischemic cardiomyopathy for use in clinical research
G. Michael Felker, MDa,*,
Linda K. Shaw, MSa and
Christopher M. O’Connor, MD, FACCa
a Duke Clinical Research Institute, Durham, North Carolina, USA
Manuscript received May 25, 2001;
revised manuscript received September 10, 2001,
accepted October 18, 2001.
* Reprint requests and correspondence: Dr. G. Michael Felker, Duke University Medical Center, Box 31185, Durham, North Carolina, USA 27710.
felke001{at}onyx.dcri.duke.edu
OBJECTIVES: We sought to evaluate the association between the extent of coronary artery disease (CAD) and survival in patients with symptomatic heart failure (HF) and to create the most prognostically powerful clinical definition of ischemic cardiomyopathy.
BACKGROUND: An ischemic etiology of HF is known to be a predictor of adverse outcome; however, there is no uniform definition for ischemic cardiomyopathy.
METHODS: We assessed the clinical history and coronary anatomy of patients with symptomatic HF and ejection fraction  40% undergoing diagnostic coronary angiography between 1986 and 1999 (n = 1,921). Five classification schemes were tested to identify the most prognostically powerful method for defining the extent of CAD and to develop the best definition of ischemic cardiomyopathy for prognostic purposes.
RESULTS: A more extensive CAD was independently associated with shorter survival. When the various classification schemes were compared, a modified number-of-diseased-vessels classification, in which patients with single-vessel disease and no prior history of revascularization or myocardial infarction (MI) were classified as nonischemic, provided the most prognostic power. A definition of ischemic cardiomyopathy that incorporated this definition had more prognostic power than the traditional definition.
CONCLUSIONS: Angiographically diagnosed ischemic HF is associated with shorter survival than nonischemic HF. A more extensive CAD is independently associated with shorter survival, and patients with single-vessel disease and no history of MI or revascularization should be classified as nonischemic for prognostic purposes. Standardization of the definition of ischemic cardiomyopathy will be useful in the conduct and interpretation of clinical research in HF.
|
Abbreviations and Acronyms
| | CAD | | coronary artery disease | | EF | | ejection fraction | | HF | | heart failure | | LAD | | left anterior descending coronary artery | | LV | | left ventricle, left ventricular | | MI | | myocardial infarction | | NYHA | | New York Heart Association |
|
This article has been cited by other articles:
|
|
|
|
 
M. St. John Sutton, S. Ghio, T. Plappert, L. Tavazzi, L. Scelsi, C. Daubert, W. T. Abraham, M. R. Gold, C. Hassager, J. M. Herre, et al.
Cardiac Resynchronization Induces Major Structural and Functional Reverse Remodeling in Patients With New York Heart Association Class I/II Heart Failure
Circulation,
November 10, 2009;
120(19):
1858 - 1865.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
O. Dzemali, P. Risteski, F. Bakhtiary, E. Singer, A. Zierer, P. Kleine, and A. Moritz
Surgical left ventricular remodeling leads to better long-term survival and exercise tolerance than coronary artery bypass grafting alone in patients with moderate ischemic cardiomyopathy.
J. Thorac. Cardiovasc. Surg.,
September 1, 2009;
138(3):
663 - 668.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Andreini, G. Pontone, A. L. Bartorelli, P. Agostoni, S. Mushtaq, E. Bertella, D. Trabattoni, G. Cattadori, S. Cortinovis, A. Annoni, et al.
Sixty-Four-Slice Multidetector Computed Tomography: An Accurate Imaging Modality for the Evaluation of Coronary Arteries in Dilated Cardiomyopathy of Unknown Etiology
Circ Cardiovasc Imaging,
May 1, 2009;
2(3):
199 - 205.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Niizuma, Y. Iwanaga, T. Yahata, Y. Goto, T. Kita, S. Miyazaki, and H. Nakahama
Plasma B-type natriuretic peptide levels reflect the presence and severity of stable coronary artery disease in chronic haemodialysis patients
Nephrol. Dial. Transplant.,
February 1, 2009;
24(2):
597 - 603.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. S. Rossi, J. D. Flaherty, G. C. Fonarow, E. Nunez, W. Gattis Stough, W. T. Abraham, N. M. Albert, B. H. Greenberg, C. M. O'Connor, C. W. Yancy, et al.
Influence of coronary artery disease and coronary revascularization status on outcomes in patients with acute heart failure syndromes: A report from OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure)
Eur J Heart Fail,
December 1, 2008;
10(12):
1215 - 1223.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J.-B. le Polain de Waroux, A.-C. Pouleur, C. Goffinet, A. Pasquet, J.-L. Vanoverschelde, and B. L. Gerber
Combined coronary and late-enhanced multidetector-computed tomography for delineation of the etiology of left ventricular dysfunction: comparison with coronary angiography and contrast-enhanced cardiac magnetic resonance imaging
Eur. Heart J.,
October 2, 2008;
29(20):
2544 - 2551.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Ghostine, C. Caussin, M. Habis, Y. Habib, C. Clement, A. Sigal-Cinqualbre, C.-Y. Angel, B. Lancelin, A. Capderou, and J.-F. Paul
Non-invasive diagnosis of ischaemic heart failure using 64-slice computed tomography
Eur. Heart J.,
September 1, 2008;
29(17):
2133 - 2140.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. C. Wu, R. G. Weiss, D. R. Thiemann, K. Kitagawa, A. Schmidt, D. Dalal, S. Lai, D. A. Bluemke, G. Gerstenblith, E. Marban, et al.
Late gadolinium enhancement by cardiovascular magnetic resonance heralds an adverse prognosis in nonischemic cardiomyopathy.
J. Am. Coll. Cardiol.,
June 24, 2008;
51(25):
2414 - 2421.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Zintzaras, G. Raman, G. Kitsios, and J. Lau
Angiotensin-Converting Enzyme Insertion/Deletion Gene Polymorphic Variant as a Marker of Coronary Artery Disease: A Meta-analysis
Arch Intern Med,
May 26, 2008;
168(10):
1077 - 1089.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. S. Sutton, D. R. Crosslin, S. H. Shah, S. C. Nelson, A. Bassil, A. B. Hale, C. Haynes, P. J. Goldschmidt-Clermont, J. M. Vance, D. Seo, et al.
Comprehensive genetic analysis of the platelet activating factor acetylhydrolase (PLA2G7) gene and cardiovascular disease in case-control and family datasets
Hum. Mol. Genet.,
May 1, 2008;
17(9):
1318 - 1328.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. G. Camici, S. K. Prasad, and O. E. Rimoldi
Stunning, Hibernation, and Assessment of Myocardial Viability
Circulation,
January 1, 2008;
117(1):
103 - 114.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Kitsios and E. Zintzaras
Genetic Variation associated with Ischemic Heart Failure: A HuGE Review and Meta-Analysis
Am. J. Epidemiol.,
September 15, 2007;
166(6):
619 - 633.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. M. Fedoruk, C. G. Tribble, J. A. Kern, B. B. Peeler, and I. L. Kron
Predicting Operative Mortality After Surgery for Ischemic Cardiomyopathy
Ann. Thorac. Surg.,
June 1, 2007;
83(6):
2029 - 2035.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Andreini, G. Pontone, M. Pepi, G. Ballerini, A. L. Bartorelli, A. Magini, C. Quaglia, E. Nobili, and P. Agostoni
Diagnostic Accuracy of Multidetector Computed Tomography Coronary Angiography in Patients With Dilated Cardiomyopathy
J. Am. Coll. Cardiol.,
May 22, 2007;
49(20):
2044 - 2050.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. B. Marcu, A. M. Beek, and A. C. van Rossum
Clinical applications of cardiovascular magnetic resonance imaging.
Can. Med. Assoc. J.,
October 10, 2006;
175(8):
911 - 917.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Gheorghiade, G. Sopko, L. De Luca, E. J. Velazquez, J. D. Parker, P. F. Binkley, Z. Sadowski, K. S. Golba, D. L. Prior, J. L. Rouleau, et al.
Navigating the Crossroads of Coronary Artery Disease and Heart Failure
Circulation,
September 12, 2006;
114(11):
1202 - 1213.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. M. Felker, W. G. Stough, L. K. Shaw, and C. M. O'Connor
Anaemia and coronary artery disease severity in patients with heart failure
Eur J Heart Fail,
January 1, 2006;
8(1):
54 - 57.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Ridocci, C. J. Soriano, and J. Estornell
Imaging approach to the assessment of cardiomyopathies using delayed enhancement cardiovascular magnetic resonance
Eur. Heart J.,
December 1, 2005;
26(23):
2601 - 2602.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Mahrholdt, A. Wagner, R. M. Judd, U. Sechtem, and R. J. Kim
Delayed enhancement cardiovascular magnetic resonance assessment of non-ischaemic cardiomyopathies
Eur. Heart J.,
August 1, 2005;
26(15):
1461 - 1474.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members, K. Swedberg, Writing Committee:, J. Cleland, H. Dargie, H. Drexler, F. Follath, M. Komajda, L. Tavazzi, O. A. Smiseth, et al.
Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology
Eur. Heart J.,
June 1, 2005;
26(11):
1115 - 1140.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. J. Soriano, F. Ridocci, J. Estornell, J. Jimenez, V. Martinez, and J. A. De Velasco
Noninvasive diagnosis of coronary artery disease in patients with heart failure and systolic dysfunction of uncertain etiology, using late gadolinium-enhanced cardiovascular magnetic resonance
J. Am. Coll. Cardiol.,
March 1, 2005;
45(5):
743 - 748.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. M. Kittleson, S. Q. Ye, R. A. Irizarry, K. M. Minhas, G. Edness, J. V. Conte, G. Parmigiani, L. W. Miller, Y. Chen, J. L. Hall, et al.
Identification of a Gene Expression Profile That Differentiates Between Ischemic and Nonischemic Cardiomyopathy
Circulation,
November 30, 2004;
110(22):
3444 - 3451.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Gattenlohner, C. Waller, G. Ertl, B.-D. Bultmann, H.-K. Muller-Hermelink, and A. Marx
NCAM(CD56) and RUNX1(AML1) Are Up-Regulated in Human Ischemic Cardiomyopathy and a Rat Model of Chronic Cardiac Ischemia
Am. J. Pathol.,
September 1, 2003;
163(3):
1081 - 1090.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. T. Kearney, J. Nolan, A. J. Lee, P. W. Brooksby, R. Prescott, A. M. Shah, A. G. Zaman, D. L. Eckberg, H.S. Lindsay, P. D. Batin, et al.
A prognostic index to predict long-term mortality in patients with mild to moderate chronic heart failure stabilised on angiotensin converting enzyme inhibitors
Eur J Heart Fail,
August 1, 2003;
5(4):
489 - 497.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. deFilippi, S. Wasserman, S. Rosanio, E. Tiblier, H. Sperger, M. Tocchi, R. Christenson, B. Uretsky, M. Smiley, J. Gold, et al.
Cardiac Troponin T and C-Reactive Protein for Predicting Prognosis, Coronary Atherosclerosis, and Cardiomyopathy in Patients Undergoing Long-term Hemodialysis
JAMA,
July 16, 2003;
290(3):
353 - 359.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J.A. McCrohon, J.C.C. Moon, S.K. Prasad, W.J. McKenna, C.H. Lorenz, A.J.S. Coats, and D.J. Pennell
Differentiation of Heart Failure Related to Dilated Cardiomyopathy and Coronary Artery Disease Using Gadolinium-Enhanced Cardiovascular Magnetic Resonance
Circulation,
July 8, 2003;
108(1):
54 - 59.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Kleikamp, A. Maleszka, N. Reiss, B. Stuttgen, and R. Korfer
Determinants of mid- and long-term results in patients after surgical revascularization for ischemic cardiomyopathy
Ann. Thorac. Surg.,
May 1, 2003;
75(5):
1406 - 1412.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. M. Felker, R. L. Benza, A. B. Chandler, J. D. Leimberger, M. S. Cuffe, R. M. Califf, M. Gheorghiade, C. M. O'Connor, and OPTIME-CHF Investigators
Heart failure etiology and response tomilrinone in decompensated heart failure: Results from the OPTIME-CHF study
J. Am. Coll. Cardiol.,
March 19, 2003;
41(6):
997 - 1003.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Tenenbaum, E. Z. Fisman, and M. Motro
Toward a redefinition of ischemic cardiomyopathy: is it an indivisible entity?
J. Am. Coll. Cardiol.,
July 3, 2002;
40(1):
205 - 206.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. M. Felker, L. K. Shaw, and C. M. O'Connor
Reply
J. Am. Coll. Cardiol.,
July 3, 2002;
40(1):
206 - 206.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. O. Cheng
Ischemic cardiomyopathy: a historical note
J. Am. Coll. Cardiol.,
May 1, 2002;
39(9):
1564 - 1565.
[Full Text]
[PDF]
|
|
|
|
