Optimal Timing Of Cardiac Catheterization In Patients With Newly Diagnosed Systolic Heart Failure. Is It Time To Rethink Our Approach?

Background Heart failure (HF) affects more than 5.1 million Americans and is responsible for more than 1 million hospitalizations each year. The Framingham Heart Study data suggests that a combination of hypertension and CAD increases the risk of HF approximately double in men and 25% in women compared to their counterparts with only hypertension. However, there is limited literature evidence with regard to the optimal timing of routine coronary angiography in the newly diagnosed HF population. Methods This is a single-center, retrospective analysis of 106 patients who were admitted with newly diagnosed acute HF exacerbation between 2016-2018. All patients underwent a transthoracic echocardiogram to identify systolic or diastolic heart failure, which was followed by a coronary angiogram. We defined ischemic cardiomyopathy (ICM) as ≥ 2 vessel disease on coronary angiography and determined a temporal trend of ICM in the newly diagnosed HF group in contemporary practice. Results Among 106 patients, 59% were male (Table 1). The patients' age ranged from 39 to 83 years with a mean age of 61. HTN and diabetes mellitus were present in 89 and 56 individuals respectively. The mean left ventricular ejection fraction was 28% with a left ventricular internal diameter in systole of 4.8 cm. ICM was diagnosed in 9 patients out of 106 (8.4%). Conclusion The incidence of ICM in contemporary practice could be lower than what we thought in the past. Further studies are needed to evaluate the optimal timing of coronary angiography in newly diagnosed HF patients