Differences between idiopathic and ischemic dilated cardiomyopathy

Abstract

Background: Ischemic cardiomyopathy can be reversible after revascularization hence the interest of making systematic coronary angiography that remain an invasive procedure.

Aim: To detect epidemiological, clinical and paraclinical differences between idiopathic and ischemic dilated cardiomyopathy to identify predictors of coronary artery disease and to evaluate the interest of making systematic coronary angiography within the etiological check-up of dilated cardiomyopathy.

Methods: We performed a retrospective study in patients with dilated cardiomyopathy in whom coronary angiography allowed to distinguish the ischemic cardiomyopathy group from that of idiopathic cardiomyopathy. We compared the clinical and paraclinical findings between these two groups.

Results: We identified 102 patients: 42 had ischemic cardiomyopathy and 60 had idiopathic cardiomyopathy. These two groups were comparable according to age and sex. Diabetes was significantly more common (p = 0.002) in the first group. Dyspnea was more common in the second group (p = 0.03) as well as atrial fibrillation and left bundle branch block (p=0,04 and p=0,05, respectively). Renal failure, fasting hyperglycemia and echocardiographic segmental wall motion abnormalities were significantly more frequent in the group of ischemic cardiomyopathy (p=0.01). In multivariate analysis, diabetes (OR=3,291, IC95% : 1,167-10,969), renal failure (OR=11,001, IC95% : 2,15-39,85) and segmental wall motion abnormalities (OR=2,351, IC95% :0.934-5.915) were independent predictors of ischemic dilated cardiomyopathy.

Conclusion: Diabetes, kidney failure and disorders of wall motion appears to be predictors for the ischemic origin of dilated cardiomyopathy and thereby help to limit the routine use of this invasive technique in the diagnosis.