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AP Ischemi Cardiomyopathy and Coronary Arteriosclerosis

Background

Arteriosclerosis is one of the most common diseases of the cardiovascular system in the western industrialized nations. Due to the increasing aging of society, an increased rate of arteriosclerosis is to be expected. In addition, there are widespread risk factors in the population such as disorders of lipid metabolism, smoking, diabetes and hypertension.

The consequence of progressive arteriosclerosis in the coronary vessels is the occlusion of the vessel lumen, which causes a myocardial infarction in the cardiac tissue downstream. This destruction of myocardial cells weakens the heart and can lead to development of chronic heart failure with reduced pumping capacity and enlargement of the heart chambers.

For patients, the reduced pumping capacity is accompanied by reduced physical performance, which in the case of severe heart failure can progress to shortness of breath at rest.

Objective

The Heinz-Nixdorf Recall study was a large scientific study of cardiovascular diseases which made it possible for the first time to generate conclusions about arteriosclerosis in the population of the Ruhr region. As part of the Heinz-Nixdorf Recall study, the calcification of the coronary blood vessels was determined using electron beam computer tomography (EBCT). The degree of coronary calcification indicates the degree of arteriosclerosis in the coronary blood vessels. Furthermore, the degree of arteriosclerosis was evaluated using indirect procedures including Doppler tests and stress tests. The information about the extent of the arteriosclerosis was linked to heart failure parameters as part of the research project. This made it possible to clarify the influence of arteriosclerosis in the development of chronic heart failure in Germany within the context of an epidemiological study. The 5-year follow-up was completed in 2008.

Main result

Modern imaging modalities (CT, MRI) allow differentiating ischemic cardiomyopathy, i.e. conditions related to a perfusion deficit, from non-ischemic cardiomyopathies. This diagnostic utility enables and enhances the early targeted and individually-tailored cause-specific treatment.

Publications

  • Schuster A et al. Imaging in the management of ischemic cardiomyopathy special focus on magnetic resonance. J Am Coll Cardiol. 2012;59:359-70.
  • Henkel DM et al. Association of myocardial fibrosis, B-type natriuretic Peptide, and cardiac magnetic resonance parameters of remodeling in chronic ischemic cardiomyopathy. Am J Cardiol. 2012;109:390-4.
  • Streitner F et al. Comparison of ventricular tachyarrhythmia characteristics in patients with idiopathic dilated or ischemic cardiomyopathy and defibrillators implanted for primary prevention. Clin Cardiol. 2011;34:604-9.

Perspective

Ongoing research within the Recall study and associated academic and industrial partners will continue to elucidate the relation between coronary calcification and the frequently observed concomitant dilatation of the ventricles of the heart.

Contact

Prof. Dr. Raimund Erbel
Universitätsklinikum Essen
Klinik für Kardiologie
Phone: +49 (0)201 7234800
E-Mail: ed.nesse-kunull@lebre