Ischemic cardiomyopathy: Why is it, still searching for a definition?

The term Ischemic cardiomyopathy(ICM)  was originally coined by Dr. Burch from Tulane University, New Orleans, USA in 1970. For many decades there was skepticism regarding the existence of such entity. WHO classification over the years never included this term. ESC working group of 2008  (Elliott P,  European Heart 29(2):270–276) decided not to include CAD as a cause for cardiomyopathy. Even the current MOGES system doesn’t invoke CAD as a cause for cardiomyopathy.  But, I am sure, most of practicing cardiologists would agree, there is a need for such an entity. Why there is much reluctance to diagnose Ischemic cardiomyopathy as a distinct entity? It is because of the basic principle, that cardiomyopathy should be a primary disease of cardiac muscle. (or at least secondary ).The presumption is, Ischemia per se doesn’t lead to muscle disease as such. It is just nutrition deprival. Does this justify? No, not at all. When a cardiac muscle is chronically deprived of nutrients it goes for necrosis, dilatation, scarring and dilatation, and progressive LV dysfunction. At some stage, it becomes true muscle disease or its equivalent (Secondary cardiomyopathy).In fact, adverse remodeling, Infarct expansion, extension lead to myocyte disarray, slippage and apoptosis, and cellular and interstitial fibrosis. All these changes are similar to Idiopathic (Postmyocarditis)cardiomyopathy. What happens in the real world? Even though there was some hesitation to diagnose ICM...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: Criteria and Nomenclature ischemic cardiomyopathy Uncategorized defintion of ischemic cardiomyopathy MOGES classification what is ischemic cardiomyopathy who whf classification of cardiomyopathy Source Type: blogs