Ischemic Cardiomyopathy Evaluation with Coronary Calcium Score and CT Angiogram

Abstract

Our study aimed to examine the prevalence of atherosclerotic burden in a predominantly non-white cohort of patients from LA County who underwent coronary artery calcium scoring (CACS) and coronary CT angiogram (CCTA) for the evaluation of cardiomyopathy of ischemic origin. Ischemic cardiomyopathy, primarily caused by reduced blood supply to the heart, is the most common type of cardiomyopathy. CCTA is a well-established and non-invasive imaging test used to assess the extent of coronary artery disease (CAD) in individuals suspected of having it. We analyzed data from 131 patients with cardiomyopathy who were referred to Harbor-UCLA Medical Center between August 2016 and September 2020. These patients had no chest pain, no q waves on electrocardiogram (ECG), and exhibited cardiomyopathy with reduced ejection fraction (EF) without wall motion abnormalities on transthoracic echocardiogram. Among the 131 patients included in our study, the average age was 54.6 years, with 93 (71%) being male. The racial distribution was as follows: 71 (54%) Hispanic, 17 (13%) White, 24 (18%) African American, and 10 (8%) Asian. Various risk factors for coronary artery disease were present, including diabetes mellitus (30%), hypertension (75%), hyperlipidemia (45%), and smoking (46%). We assessed CACS using the Agatston score, while atherosclerotic disease burden was evaluated using total plaque score (TPS), total segment stenosis score (TSSS), and segment involvement score (SIS). Of the patients, 55 (42%) had a CACS of zero, 28 (21%) had a CACS below 10, and the median (interquartile range) of TPS was 1 (1, 5). The median TSSS and SIS were both 1 (1, 5) and 0 (1, 4), respectively. A total of 23 patients (18%) exhibited 50% stenosis indicative of obstructive CAD, while 13 patients (10%) had even more severe stenosis of 75% or greater. Our findings revealed that the majority of patients in our cohort had non-obstructive CAD, suggesting that non-ischemic factors were the primary cause of their cardiomyopathy. Additionally, our study demonstrated that CCTA is an effective non-invasive diagnostic tool for cardiomyopathy, allowing for the avoidance of more invasive procedures in a predominantly non-white population receiving care at a public hospital in LA County.