[Clinical manifestations, therapeutic methods and prognosis of patients with ischemic cardiomyopathy].

ABSTRACT

In view of the increased prevalence of so-called "ischemic cardiomyopathy" ( Burch ) in Japan, we attempted to clarify the clinical manifestations of this condition and to investigate the medical treatment in comparison with the surgical therapy. Eighteen patients (17 males and one female) were identified as having "ischemic cardiomyopathy" according to the following criteria These include (i) an ejection fraction of 30% or less with asynergy on all segments of AHA classification, (ii) significant coronary stenosis (75% or more) of one or more major coronary branches, and (iii) no other coexisting lesion, such as primary valvular disease or congenital heart disease. In the history, distinct myocardial infarction or angina pectoris was observed in 10 cases (56%), and in the remaining eight cases (44%) only symptoms of cardiac failure was shown. On the ECG, all cases showed pathologic Q waves. Moreover, 10 cases (56%) of these had Q waves in five leads or more. Cardiomegaly on the chest X-ray film (CTR greater than or equal to 60%) was evident in 10 cases and that on echocardiogram ( LVDd greater than or equal to 60 mm) in 16 cases. Physical examinations demonstrated gallop sounds in 89% and a B-B' step formation on echocardiograms in 50%. The LVEDP was greater than 12 mmHg in 13 cases, and the systolic pressure of the pulmonary artery was higher than 35 mmHg in 13 cases. On the other hand, the reduced cardiac index (less than or equal to 2.21/min/M2) was observed in only one case. Selective CAG revealed multiple vessel disease in 78%. Ten of the 18 cases had mitral regurgitation demonstrated by left ventriculography.(ABSTRACT TRUNCATED AT 250 WORDS)