Cardiomyopathic syndrome due to coronary artery disease: I: Relation to angiographic extent of coronary disease and to remote myocardial infarction

Abstract

The relation between the extent of angiographic coronary artery disease and the presence of chronic heart failure in patients with coronary artery disease has not hitherto been clearly elucidated. In the present study clinical, ventriculographic, and coronary arteriographic features are compared in 84 patients with coronary artery disease. The extent of coronary disease is measured by the angiographicjeopardy score, which expresses how many of six coronary arterial segments are jeopardised by significant (> 70% estimated luminal area reduction) proximal stenoses. Each jeopardised segment is counted as 2 points. Thirty of the 84 patients had clinical evidence of chronic heart failure, all of whom were classified as having a cardiomyopathic syndrome caused by coronary artery disease since all had significant reduction of the left ventricular ejection fraction (<0.48) because of multiple and widespread left ventricular wall motion abnormalities. There were no patients in this study with chronic heart failure from other causes (e.g. isolated ventricular aneurysm). The mean jeopardy score in the patients with cardiomyopathy was much higher than in the patients without cardiomyopathy (10.7±0.4 vs 5.3±0.6, P<0.01), and all patients with cardiomyopathy had a jeopardy score ≥8. Distal coronary artery disease was unrelated to the presence or absence of cardiomyopathy (0.5± 0.2 vs 0.4 ± 0.2 diseased distal vessels per patient). Cardiomyopathy was strongly associated with the occurrence of multiple myocardial infarcts (1.9±0.3 myocardial infarcts per patient) in the group with cardiomyopathy and 0.9±0.2 myocardial infarcts per patient in the group without it; 19 of 30 (64%) patients with cardiomyopathy had ≥2 myocardial infarcts, whereas 11 of 54 (20%) without had ≥2 myocardial infarcts (P<0.001). The findings of this study, that cardiomyopathy due to coronary artery disease is specifically related to the extent of proximal coronary artery disease and to the occurrence of multiple myocardial infarcts, constitute reasons for distinguishing this cardiomyopathic syndrome from the several other causes of chronic heart failure in coronary artery disease. The angiographic scoring system used here, which more precisely relates the extent of coronary disease to the extent of left ventricle involved, was a stronger predictor of the presence or absence of the cardiomyopathic syndrome than the 1, 2, 3-vessel disease notation.