Predictors of coronary angiography in patients with idiopathic dilated cardiomyopathy: the Washington, DC Dilated Cardiomyopathy Study

Spectrum of heart failure in sub-Saharan Africa: data from a tertiary hospital-based registry in the eastern center of Burkina Faso

Introduction

Heart failure (HF) is a strong contributor to non-communicable diseases burden in sub-Saharan Africa (SSA). Few studies have addressed the pattern of HF in Burkina Faso.

Methods

We conducted a prospective cohort study in patients with acute HF in the Regional Hospital Center of Tenkodogo, eastern region of Burkina Faso. Patients were consecutively enrolled from 1^st January 2015 to 31^st December 2016 and followed up until June 2017. Primary outcome of interest was mortality.

Results

Overall 318 of 1805 cardiac cases presented with acute HF (17.62 %). Of the 298 patients included in the analysis process, 239 had de novo HF and 150 were male. The mean age was 58.56 ± 18.54 years. Eighty-eight patients presented with atrial fibrillation. The mean left ventricular ejection fraction (LVEF) was 38.20 ± 12.85 % with reduced ejection fraction (LVEF < 40%) accounting for 59.73% of the cases. Most of the study patients lived in rural areas. Hypertensive heart disease (50.34%) and idiopathic dilated cardiomyopathy (19.80%) were the leading causes of HF. Most patients received renin-angiotensin system blockers contrasting with a lower prescription rate of beta-blockers (99% versus 18.79% respectively). The incidence of all-cause mortality was 31 percent patients-years.

Conclusion

Heart failure is frequent in SSA, affecting patients at younger age. Predominantly of non-ischemic cause, commonly hypertensive, the disease is associated with high mortality.

Towards risk factor assessment in inflammatory dilated cardiomyopathy: the SFB/TR 19 study

BACKGROUND

Patients with idiopathic dilated cardiomyopathy (DCMid) account for about one-third of patients with heart failure. Recent studies found a myocardial viral genomic persistence in up to 67% of DCMid patients, indicating a possible inflammatory etiology (DCMi). Considering the importance of DCMi, we aimed to study the present knowledge on risk factors in DCMi.

METHODS

Review of published literature on risk factors for DCMi/DCMid from 1989 through 2005 in Medline database and the Cochrane library (search terms 'epidemiology', 'risk factors', 'inflammatory dilated cardiomyopathy' and 'idiopathic dilated cardiomyopathy').

RESULTS

An extended array of risk factors in DCMid has been investigated in 11 studies. No studies addressing specifically DCMi, however, were found. Consistent associations with DCMid were reported only for diabetes mellitus, black race, male sex and estimated low income. Inconsistent results were observed for the presence of asthma, hypertension and smoking. Few studies addressed potential risk factors such as low education level, infectious diseases and environmental factors.

CONCLUSIONS

Considering the high number of potential DCMi patients among patients with DCMid, results on risk factors for DCMid are likely relevant to at least a number of patients with DCMi. Future studies of risk factors in DCMi should include specific case classification and the application of standardized instruments for risk-factor assessment. The four-center SFB/TR 19 study aims to establish a prospective cohort of DCMi patients validated by endomyocardial biopsy.

Heart failure due to ischaemic heart disease: epidemiology, pathophysiology and progression

Ischaemic heart disease is the most common underlying cause of heart failure in industrialised countries. Its manifestations are protean with myocardial infarction being only one important facet. The prognosis of patients with heart failure due to ischaemic heart disease also appears to be worse than that associated with many other aetiologies. The presence of ischaemic heart disease may influence both the efficacy and choice of treatment. Agents such as digoxin and amlodipine appear less effective in patients with ischaemic heart disease while ACE inhibitors and beta-blockers appear as or more effective in patients with ischaemic heart disease. Many have expressed an opinion about how coronary disease should be managed in the patient with heart failure supported by little or no evidence. There are major theoretical and practical concerns about the use of anti-coagulant, anti-platelet and statin therapy in patients with heart failure as well as major theoretical benefits. Only randomised controlled trials will resolve these issues. The same may be said of revascularisation. Fortunately trials addressing all these areas are under way. This should put the management of coronary disease in patients with heart failure on a firm evidence-based footing.

Incidence, clinical and etiologic features, and outcomes of advanced chronic heart failure: the EPICAL Study. Epidémiologie de l'Insuffisance Cardiaque Avancée en Lorraine

OBJECTIVES

Characterize the incidence, clinical and etiologic features and outcomes of advanced congestive heart failure.

BACKGROUND

This condition is frequent, severe and costly, yet no population-based epidemiological data are available that take into account modern advances in diagnosis and therapy.

METHODS

The EPICAL (Epidémiologie de l'Insuffisance Cardiaque Avancée en Lorraine) study was based on a comprehensive registration of patients with ACHF (defined as hospital admission for presence of NYHA class III or IV symptoms, radiological and/or clinical signs of pulmonary congestion and/or signs of peripheral edema, left ventricular ejection fraction <30% or a cardiothoracic ratio >60%) in patients aged 20-80 years during year 1994, in the community of the Lorraine region in France (n = 1,592,263). Average follow-up for readmission to hospital and mortality was 18 months (12-24 months).

RESULTS

From 2,576 registered patients, 499 were enrolled into the study among which, 358 were new presentations. This represents a crude incidence rate of 225 per million. 46.3% had a coronary heart disease. One-year mortality rate was 35.4% and the rate of mortality and/or readmission to hospital was 81%. Patients were admitted to hospital 2.05 times per year (64% of these for worsening heart failure), spending 27.6 days per year in hospital. Twenty received a heart transplant (4%). On discharge, 74.8% were using ACE inhibitors and 49.6% digitalis.

CONCLUSIONS

Mortality and hospitalization rate of advanced CHF remain very high despite recent therapeutic progress. Major therapeutic and managed-care research is required.

Angiography and the aetiology of heart failure

The diagnosis of idiopathic dilated cardiomyopathy should not be made without first performing a coronary angiogram. If the cause of heart failure is unknown this should be stated rather than attributing the cause to dilated cardiomyopathy. Severe ventricular dysfunction may improve dramatically after revascularisation in some cases of coronary disease. Preservation of R waves on the surface electrocardiogram suggests the presence of hibernating myocardium but thallium scintigraphy or positron emission tomography scanning should be employed to investigate this further.