title: Clinical usefulness of coronary angiography in patients with left ventricular dysfunction.
abstract: BACKGROUND
  Performing a coronary angiography in patients with heart failure of unknown etiology is often justified by the diagnostic assessment of ischemic heart disease. However, the clinical benefit of this strategy is not known.
  
  
  OBJECTIVE
  To evaluate the prevalence of ischemic heart disease by angiographic criteria in patients with heart failure and reduced ejection fraction of unknown etiology, as well as its impact on therapy decisions.
  
  
  METHODS
  Consecutive outpatients with heart failure and systolic dysfunction, who had an indication for coronary angiography to clarify the etiology of heart disease were assessed from 1 January 2009 to December 31, 2010. Patients diagnosed with coronary artery disease, positive serology for Chagas disease, congenital heart disease, valve disease or patients undergoing cardiac transplantation were excluded from the analysis. The sample was divided into two groups according to the indication for catheterization. Group-1: Symptomatic due to angina or heart failure. Group-2: Presence of > 2 risk factors for coronary artery disease
  
  
  RESULTS
  One hundred and seven patients were included in the analysis, with 51 (47.7%) patients in Group 1 and 56 (52.3%) in Group 2. The prevalence of ischemic heart disease was 9.3% (10 patients), and all belonged to Group 1 (p = 0.0001). During follow-up, only 4 (3.7%) were referred for CABG; 3 (2.8%) patients had procedure-related complications.
  
  
  CONCLUSIONS
  In our study, coronary angiography in patients with heart failure and systolic dysfunction of unknown etiology, although supported by current guidelines, did not show benefits when performed only due to the presence of risk factors for coronary artery disease.
authors.affiliation: Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil. vieirademelorm@gmail.com
authors.forename: Rodrigo Morel Vieira de
authors.initials: RM
authors.lastname: Melo
authors.forename: Eduardo França Pessoa de
authors.initials: EF
authors.lastname: Melo
authors.forename: Bruno
authors.initials: B
authors.lastname: Biselli
authors.forename: Germano Emilio Conceição
authors.initials: GE
authors.lastname: Souza
authors.forename: Edimar Alcides
authors.initials: EA
authors.lastname: Bocchi
mesh_terms: D000328:Adult; D001938:Brazil / Q000453:epidemiology; D017023:Coronary Angiography; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology