CONGRESS ABSTRACT

Ischaemic cardiomyopathy is the leading cause of HFrEF and revascularization combined with GDMT synergistically improves systolic LV function and overall prognosis in patients with ischaemic HFrEF. According to current ESC guidelines, invasive coronary angiography may be considered in patients with HFrEF with an intermediate to high pre-test probability of CAD and presence of ischaemia in non-invasive stress tests; CTCA should be considered in patients with a low to intermediate pre-test probability of CAD or those with equivocal non-invasive stress tests. In clinical practise, non-invasive stress tests often cannot be safety performed in patients acutely hospitalized for HFrEF and CTCA is not widely available. We retrospectively analyzed patients affected by AHF with a first diagnosis of hypokinetic cardiomyopathy (EF≤40%) hospedalized in our ICCU from January 2022 to June 2024. Cardiovascular anamnesis had be silent. Patients with acute coronary syndrome or moderate-severe valvulopathy were excluded. 41 subjects (31 male and 10 female) were hospedalized for AHF associated with a new diagnosis of left ventricle systolic disfunction (mean EF 25%). Mean age was 63±12yo. In 38 subjects we performed invasive coronary angiography; AKI, EF improvement or non-ischemic pattern at cardiac RM were the reasons for waiver of the exam in 3 remaining cases. Among the 38 invasive examinations, 15 patients (39%) had a significant coronary disease: 7 single-vessel (left anterior descending affected in 5 cases), 2 bi-vessel and 6 three vessel disease (4 revascularized by CABG and 2 by PCI). Among 12 subjects with persistent AF at presentation and likely tachycardiomyopathy, 25% had a significant CAD. Applying the RF-CL risk factor-weighted clinical likelihood we found out that none patients with a very low probability had CAD; among 12 subjects with a low probability, 33% had CAD (also a three vessel disease in 1 case); among 16 patients with intermediate risk, CAD occurred in 50%, while 100% of high risk subjects (3) had ischaemic HFrEF. Ischaemic risk stratification can help to foresee the presence of CAD in these patients. In our experience invasive coronary angiography seems justified in intermediate-high risk patients hospedalized for AHF with a first diagnosis of hypokinetic cardiomyopathy, without previous stress tests. In low risk patients, we found a not neglectable presence of CAD (33%): in this group CTCA could be the best exam to exclude the ischaemic etiology.