Key result
Atypical regional wall motion abnormalities are linked to ~14-fold higher odds of ischaemic cardiomyopathy.
Why the study?
Coronary angiography is recommended to exclude ischaemic heart disease in HFrEF with dilated left ventricle, but its utility is limited in LMICs by resource constraints and lower CAD prevalence.
Does a risk-based clinical and echocardiographic prediction model accurately identify non-ischaemic aetiology in adults with HFrEF and a dilated left ventricle, to reduce the need for routine angiography?
Observational (n=159)
Outcome assessor blinded
No
Does a risk-based clinical and echocardiographic prediction model accurately identify non-ischaemic aetiology in adults with HFrEF and a dilated left ventricle, to reduce the need for routine angiography?
A simple risk model combining the absence of angina, dyslipidaemia, LV wall thinning, and atypical RWMA can accurately identify non-ischaemic HFrEF, which could safely reduce the burden of routine invasive coronary angiography in resource-limited settings.
Answers are grounded in this paper and cite their sources.
May support non-ischaemic HFrEF prediction to defer angiography; leaves open prospective validation before any practice change.
Background: Ischaemic heart disease (IHD) is a common cause of heart failure with reduced ejection fraction (HFrEF) and a dilated left ventricle not due to volume overload. While coronary angiography is recommended to delineate coronary anatomy, its utility in low- to middle-income countries (LMIC) is limited by resource constraints and a lower prevalence of coronary artery disease (CAD). Methods: This retrospective study included 159 patients referred to the SUNHEART Outreach Programme with HFrEF and a dilated left ventricle not due to volume overload. Using coronary angiography as the gold standard, clinical history, electrocardiogram (ECG), blood results, and echocardiographic features were analysed to differentiate ischaemic from non-ischaemic aetiologies. Results: Of 159 patients (median age 55 years, 79% male), 114 patients (72%) had non-ischaemic cardiomyopathy. Patients with ischaemic cardiomyopathy were more likely to have atypical regional wall motion abnormalities (RWMA) on echocardiography (odds ratio [OR] 13.98, 5.60–34.91) and left ventricular wall thinning (OR 4.85, 1.29–18.19). The absence of angina, dyslipidaemia, atypical RWMA, and left ventricular wall thinning on echocardiogram predicted a 95% probability of non-ischaemic cardiomyopathy ( p < 0.01). Conclusion: The absence of angina, dyslipidaemia, atypical RWMA, and left ventricular wall thinning on echocardiography favours non-ischaemic cardiomyopathy, supporting selective rather than routine angiography in resource-limited settings.
No takes yet. Share an insight, caveat, or question.
Knoetzen et al. (2026) conducted an observational in Heart failure with reduced ejection fraction (HFrEF) (n=159). Atypical regional wall motion abnormalities (RWMA) vs. Typical RWMA was evaluated on Ischaemic cardiomyopathy diagnosis (OR 13.98, 95% CI 5.60-34.91, p=<0.01). Atypical regional wall motion abnormalities predicted ischaemic cardiomyopathy (OR 13.98), while absence of angina, dyslipidaemia, and atypical echo features predicted a 95% non-ischaemic probability.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: