Abstract 15558: Clinical and Electrographic Predictors of Ischemic Cardiomyopathy During Initial Evaluation of Patients With Reduced Left Ventricular Ejection Fraction
Introduction: The initial evaluation of cardiomyopathy (CM) is a common diagnostic challenge. Invasive coronary angiography is routinely performed to exclude ischemic cardiomyopathy (ICM). Clinical data and electrocardiographic (ECG) interpretation may predict the likelihood of ICM and obviate the need for invasive testing in some patients.
Study Design: Medical records of adults referred for coronary angiography for evaluation of CM (LVEF ≤ 40%) from 2010-2014 were retrospectively reviewed. Patients with myocardial infarction (MI), prior coronary revascularization, cardiac surgery, or severe left-sided primary valvular disease were excluded. ICM was defined as a ≥70% stenosis of the left main, proximal left anterior descending, or ≥2 vessel coronary artery disease. Two reviewers, blinded to angiographic outcomes, performed ECG interpretation. A clinical risk model was developed from logistic regression coefficients, with a dichotomous cut-point of ≥3.5, based on the maximal Youden’s index from the receiver operating characteristic curve.
Results: Among 5,042 patients referred for coronary angiography, 273 met inclusion criteria. Mean age was 56.8±11.6, 68.1% were men. ICM was identified in 41 patients (15.0%). Patients with ICM were older, more likely to have diabetes mellitus (DM), peripheral arterial disease, and a history of tobacco use (p<0.05). Patients with ICM were more likely to have Q-wave MI (34.1% vs. 12.5%, p<0.001) and ST or T-waves changes suggestive of ischemia (22.0% vs. 9.1%, p=0.02). A model based on clinical and ECG data yielded a 95% negative predictive value for ICM (Table).
Conclusions: In an urban referral hospital with diverse etiologies of CM, the prevalence of ICM was low. A simple clinical model incorporating the absence of advanced age, hypertension, DM, tobacco use, and ECG changes can identify patients at a low likelihood for ICM in whom a noninvasive strategy should be considered prior to invasive coronary angiography.
Author Disclosures: A.R. Devanabanda: None. N.R. Smilowitz: None. G. Zakhem: None. S. Iqbal: None. W. Slater: None. J. Coppola: None.
- © 2016 by American Heart Association, Inc.