Key result
CCTA reveals obstructive CAD in only 18% of newly diagnosed cardiomyopathy patients without chest pain.
Why the study?
The study aimed to examine the prevalence of atherosclerotic burden using CACS and CCTA in a predominantly non-white cohort evaluated for cardiomyopathy of ischemic origin.
Observational (n=131)
No
In a predominantly non-white cohort with newly diagnosed cardiomyopathy without typical ischemic features, CCTA revealed that the majority had non-obstructive CAD, supporting its use to rule out ischemic etiology non-invasively.
Answers are grounded in this paper and cite their sources.
Adds prevalence data in non-white LA County patients; leaves open whether CACS/CCTA findings alter ischemic cardiomyopathy management.
Our study aimed to examine the prevalence of atherosclerotic burden in a predominantly non-white cohort of patients from LA County who underwent coronary artery calcium scoring (CACS) and coronary CT angiogram (CCTA) for the evaluation of cardiomyopathy of ischemic origin. Ischemic cardiomyopathy, primarily caused by reduced blood supply to the heart, is the most common type of cardiomyopathy. CCTA is a well-established and non-invasive imaging test used to assess the extent of coronary artery disease (CAD) in individuals suspected of having it. We analyzed data from 131 patients with cardiomyopathy who were referred to Harbor-UCLA Medical Center between August 2016 and September 2020. These patients had no chest pain, no q waves on electrocardiogram (ECG), and exhibited cardiomyopathy with reduced ejection fraction (EF) without wall motion abnormalities on transthoracic echocardiogram. Among the 131 patients included in our study, the average age was 54.6 years, with 93 (71%) being male. The racial distribution was as follows: 71 (54%) Hispanic, 17 (13%) White, 24 (18%) African American, and 10 (8%) Asian. Various risk factors for coronary artery disease were present, including diabetes mellitus (30%), hypertension (75%), hyperlipidemia (45%), and smoking (46%). We assessed CACS using the Agatston score, while atherosclerotic disease burden was evaluated using total plaque score (TPS), total segment stenosis score (TSSS), and segment involvement score (SIS). Of the patients, 55 (42%) had a CACS of zero, 28 (21%) had a CACS below 10, and the median (interquartile range) of TPS was 1 (1, 5). The median TSSS and SIS were both 1 (1, 5) and 0 (1, 4), respectively. A total of 23 patients (18%) exhibited 50% stenosis indicative of obstructive CAD, while 13 patients (10%) had even more severe stenosis of 75% or greater. Our findings revealed that the majority of patients in our cohort had non-obstructive CAD, suggesting that non-ischemic factors were the primary cause of their cardiomyopathy. Additionally, our study demonstrated that CCTA is an effective non-invasive diagnostic tool for cardiomyopathy, allowing for the avoidance of more invasive procedures in a predominantly non-white population receiving care at a public hospital in LA County.
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Kumar et al. (2023) conducted an observational in Cardiomyopathy with reduced ejection fraction (n=131). Coronary artery calcium scoring and coronary CT angiogram was evaluated on Prevalence of obstructive coronary artery disease (≥50% stenosis). In a predominantly non-white cohort with newly diagnosed cardiomyopathy and no chest pain, only 18% had obstructive coronary artery disease on coronary CT angiography.
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