Tiago Borges, Filipa Silva, Ana Ribeiro, Raquel Mesquita, João Carlos Silva, Pedro Almeida and Paulo Bettencourt
Introduction: Coronary artery disease (CAD) is a major cause of heart failure with reduced ejection fraction (HFrEF). Current practice guidelines suggest that coronary angiography (CA) should be considered in patients with HFrEF without angina. Since echocardiography is a low cost, noninvasive, widely available imaging method we aimed to determine the association of regional wall motility anomalies with the presence and severity of CAD. Methods: We retrospectively identified consecutive patients submitted to coronary angiography in a Heart Failure (HF) clinic and with a technically satisfactory 2D echocardiography study. Patients with preserved ejection fraction and those reporting angina, with known CAD or submitted to coronary angiography for other purposes, were excluded. Demographic and echocardiographic variables, HF characteristics and angiographic data were abstracted from clinical records. Results: Of the 162 patients with HFrEF included, significant CAD was present in 37 patients and severe CAD in 18 patients. No correlation was found between the presence of regional wall motion abnormalities (RWMA) and significant CAD (p=0.48), but a significant association was present between akinetic areas and (significant or severe) CAD, which was also observed considering each of the three main coronary arteries. The calculated odd ratio of having CAD in the presence of akinetic areas was 7.0 (CI 2.8-17.7). Conclusion: In patients with HFrEF of unknown etiology, akinetic areas on echocardiogram are suggestive of an ischemic etiology. Our results support the performance of a CA in HFrEF with akinetic areas in the echocardiogram.
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