Predictors of coronary angiography in patients with idiopathic dilated cardiomyopathy: the Washington, DC dilated cardiomyopathy study

  • Robert E. Benton
    Division of Clinical Pharmacology, Department of Medicine, Georgetown University School of Medicine, Washington, DC, USA
    Search for articles by this author
  • Steven S. Coughlin
    All correspondence should be addressed to: Steven S. Coughlin, Ph.D., Associate Professor, Department of Biostatistics and Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1430 Tulane Avenue, New Orleans, LA 70112, USA
    Department of Biostatistics and Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
    Search for articles by this author
  • Mariella C. Tefft
    Lombardi Cancer Research Center, Division of Medical Oncology, Georgetown University Medical Center, Washington, DC, USA
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.


      Although a number of clinical and demographic factors have been associated with the performance of angiography in cardiac patients, clinical studies of idiopathic dilated cardiomyopathy (DCM) have often excluded patients who have not undergone coronary angiography to rule out coronary artery disease (CAD). To examine the impact of this diagnostic criterion on population-based studies of idiopathic DCM, we examined characteristics of probable cases of DCM who did or did not have a recorded history of angiography. The cases (n = 129) were ascertained from five medical centers in the Washington, DC metropolitan area over the period 1 July 1990 through 29 February 1992. All of these cases had evidence of ventricular dilation and hypokinesis, with a left ventricular ejection fraction of less than 40%. Cases with a history of known CAD, congenital heart disease, valvular heart disease, or secondary cardiomyopathy were excluded. Sixty-two (48%) of the cases had a recorded history of angiography. Age, educational level, diabetes, alcohol use, insurance status, and type of hospital were significantly associated with angiography in bivariate analysis (p < 0.05). Diabetes and hypertension were inversely associated with history of angiography among black cases, and positively associated with angiography among whites. In logistic regression analysis, age was the strongest independent predictor of angiography (p < 0.025). The associations with educational attainment and alcohol use were of borderline significance (p < 0.10). Thus, in epidemiologic studies of idiopathic DCM, particularly in biracial populations, the exclusion of cases who have not undergone angiography may bias risk estimates and result in the underestimation of incidence and prevalence.


      To read this article in full you will need to make a payment


        • Tamburro P.
        • Wilber D.
        Sudden death in idiopathic dilated cardiomyopathy.
        Am Heart J. 1992; 124: 1035-1045
        • Coughlin S.S.
        • Szklo M.
        • Baughman K.
        • et al.
        The epidemiology of idiopathic dilated cardiomyopathy in a biracial community.
        Am J Epidemiol. 1990; 131: 48-56
        • Coughlin S.S.
        • Labenberg J.R.
        • Tefft M.C.
        Black-white differences in idiopathic dilated cardiomyopathy: The Washington, DC Dilated Cardiomyopathy Study.
        Epidemiology. 1993; 4: 165-172
        • Coughlin S.S.
        • Pearle D.L.
        • Baughman K.L.
        • et al.
        Diabetes mellitus and risk of idiopathic dilated cardiomyopathy: The Washington, DC Dilated Cardiomyopathy Study.
        Ann Epidemiol. 1994; 4: 45-52
        • Manolio T.A.
        • Baughman K.L.
        • Rodeheffer R.
        • et al.
        The prevalence and etiology of idiopathic dilated cardiomyopathy: Summary of an NHLBI workshop.
        Am J Cardiol. 1992; 69: 1458-1466
        • Wynne J.
        • Braunwald E.
        The cardiomyopathies and myocarditis.
        in: Braunwald E. Heart Diseasae: A Textbook of Cardiovascular Medicine. W.B. Saunders Co.,, Philadelphia, PA1988: 1410-1469
        • Criqui M.H.
        • Wallace R.B.
        • Mishkel M.
        • et al.
        Alcohol consumption and blood pressure: The Lipid Research Clinics Prevalence Study.
        Hypertension. 1981; 3: 557-565
        • Kahn H.A.
        • Sempos C.T.
        Statistical Methods in Epidemiology.
        Oxford University Press, New York1989
        • Breslow N.E.
        • Day N.E.
        2nd edn. Statistical Methods in Cancer Research: Vol. 1. The Analysis of Case-Control Studies. International Agency for Research on Cancer, Lyon, France1980
        • Schlesselman J.J.
        Case-Control Studies: Design, Conduct, Analysis.
        Oxford University Press, New York1982
        • Coughlin S.S.
        • Metayer C.
        Re: Idiopathic dilated cardiomyopathy (letter).
        Epidemiology. 1994; (in press)
        • Figulla H.R.
        • Kellermann A.B.
        • Stille-Siegener M.
        • et al.
        Significance of coronary angiography, left heart catheterization, and endomyocardial biopsy for the diagnosis of idiopathic dilated cardiomyopathy.
        Am Heart J. 1992; 124: 1251-1257
        • Diamond G.A.
        • Forrester J.S.
        Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease.
        N Engl J Med. 1979; 300: 1350-1358
        • Ransohoff D.F.
        • Feinstein A.R.
        Problems of spectrum and bias in evaluating the efficacy of diagnostic tests.
        N Engl J Med. 1978; 299: 926-930
        • Codd M.B.
        • Sugrue D.D.
        • Gersh B.J.
        • Melton L.J.
        Epidemiology of idiopathic dilated and hypertrophic cardiomyopathy: A population-based study in Olmsted County, Minnesota, 1975–1984.
        Circulation. 1989; 80: 564-572
        • Sugrue D.D.
        • Rodeheffer R.J.
        • Codd M.B.
        • et al.
        The clinical course of idiopathic dilated cardiomyopathy.
        Ann Intern Med. 1992; 117: 117-123
        • Hannan E.L.
        • Kilburn H.
        • O'Donnell J.F.
        • et al.
        Interracial access to selected cardiac procedures for patients hospitalized with coronary artery disease in New York State.
        Med Care. 1991; 29: 430-441
        • Ford E.
        • Cooper R.
        • Castaner A.
        • et al.
        Coronary arteriography and coronary bypass surgery among whites and other racial groups relative to hospital-based incidence rates for coronary artery disease: Findings from NHDS.
        Am J Public Health. 1989; 79: 437-440
        • Young M.J.
        • Fried L.S.
        • Eisenberg J.
        • et al.
        Do cardiologists have higher thresholds for recommending coronary arteriography than family physicians?.
        Health Ser Res. 1987; 22: 623-635
        • Strogatz D.S.
        Use of medical care for chest pain: differences between blacks and whites.
        Am J Public Health. 1990; 80: 290-294
        • James S.A.
        • Wagner E.H.
        • Strogatz D.S.
        • et al.
        The Edgecombe County (NC) high blood pressure control program: II. Barriers to the use of medical care among hypertensives.
        Am J Public Health. 1984; 74: 468-472
        • Coughlin S.S.
        • Gottdiener J.S.
        • Baughman K.L.
        • et al.
        Black-white differences in mortality in idiopathic dilated cardiomyopathy: The Washington, DC Dilated Cardiomyopathy Study.
        J Nall Med Assoc. 1994; (in press)
        • Ayanian J.Z.
        • Epstein A.M.
        Differences in the use of procedures between women and men hospitalized for coronary heart disease.
        N Engl J Med. 1991; 325: 221-225
        • Steingart R.M.
        • Packer M.
        • Hamm P.
        • et al.
        Sex differences in the management of coronary artery disease.
        N Engl J Med. 1992; 325: 226-230
        • Concato J.
        • Feinstein A.R.
        • Holford T.R.
        The risk of determining risk with multivariable models.
        Ann Intern Med. 1993; 118: 201-210
        • Torp A.
        Incidence of congestive cardiomyopathy.
        Postgrad Med J. 1978; 54: 435-437
        • Bagger J.P.
        • Baandrup U.
        • Rasmussen K.
        • et al.
        Cardiomyopathy in western Denmark.
        Br Heart J. 1984; 52: 327-331
        • Williams D.G.
        • Olsen E.G.J.
        Prevalence of overt dilated cardiomyopathy in two regions of England.
        Br Heart J. 1985; 54: 153-155
        • Herd R.
        • Hillman R.
        • Irving J.B.
        The natural history of dilated cardiomyopathy-a community study.
        Scot Med J. 1991; 36: 133-135
        • Coughlin S.S.
        • Comstock G.W.
        • Baughman K.L.
        The descriptive epidemiology of idiopathic dilated cardiomyopathy in Washington County, Maryland, 1975–1991.
        J Clin Epidemiol. 1993; 46: 1003-1008