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Ischemic cardiomyopathy: epidemiology, pathophysiology, outcomes, and therapeutic options

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Abstract

Ischemic cardiomyopathy (ICM) is the most prevalent cause of heart failure (HF) in developed countries, with significant morbidity and mortality, despite constant improvements in the management of coronary artery disease. Current literature on this topic remains fragmented. Therefore, this review aimed to summarize the most recent data on ICM, focusing on its definition, epidemiology, outcomes, and therapeutic options. The most widely accepted definition is represented by a left ventricular dysfunction in the presence of significant coronary artery disease. The prevalence of ICM is largely influenced by age and sex, with older individuals and males being more affected. Its pathophysiology is characterized by plaque buildup, thrombus formation, hypoperfusion, ischemic cell death, and left ventricular remodeling. Despite improvements in therapy, ICM still represents a public health burden, with a 1-year mortality rate of 16% and a 5-year mortality rate of approximately 40% in the USA and Europe. Therefore, optimization of cardiovascular function, prevention of progressive remodeling, reduction of HF symptoms, and improved survival are the main goals of treatment. Therapeutic options for ICM include lifestyle changes, optimal medical therapy, revascularization, device therapy, mechanical circulatory support, and cardiac transplantation. Personalized management strategies and tailored patient care are needed to improve the outcomes of patients with ICM.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, NY, USA

    Paola Pastena, Jesse T. Frye, Marc E. Goldschmidt & Andreas P. Kalogeropoulos

  2. College of Arts and Sciences, Stony Brook University, Stony Brook, NY, USA

    Carson Ho

  3. Stony Brook University Medical Center, Health Sciences Center, 101 Nicolls Road, T-16-080, Stony Brook, NY, USA

    Andreas P. Kalogeropoulos

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  1. Paola Pastena
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Dr. Pastena has led literature review and drafting, Dr. Frye has contributed to editing and drafting, Mr. Ho has contributed to review and drafting (pathophysiology), Dr. Goldschmidt has contributed to editing and drafting, and Dr. Kalogeropoulos contributed to conceptualization, structure, drafting, and oversight.

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Correspondence to Andreas P. Kalogeropoulos.

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Pastena, P., Frye, J.T., Ho, C. et al. Ischemic cardiomyopathy: epidemiology, pathophysiology, outcomes, and therapeutic options. Heart Fail Rev 29, 287–299 (2024). https://doi.org/10.1007/s10741-023-10377-4

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