Prevalence and Angiographic Severity of Obstructive Coronary Artery Disease in Patients Presenting with a Dilated Cardiomyopathy Phenotype: A Retrospective Single-Center Cohort Study.
In a retrospective single-center cohort of patients presenting with a dilated cardiomyopathy phenotype referred for coronary angiography, obstructive CAD was present in fewer than one in five patients, but when present, three-vessel disease and severe occlusive lesions were frequent.
Key Findings
Results
Obstructive coronary artery disease was identified in 17.8% of patients presenting with a dilated cardiomyopathy phenotype who underwent diagnostic invasive coronary angiography.
19 of 107 patients had obstructive CAD (95% CI, 11.7–26.1%)
Obstructive CAD was defined as stenosis >70% in a major epicardial coronary artery with a reference vessel diameter >2.5 mm
The remaining 88 patients (82.2%) had non-obstructive or no significant coronary stenoses
Study period spanned January 2010 to December 2025 at St. Marina University Hospital, Varna, Bulgaria
Results
Among patients with obstructive CAD, three-vessel disease was the most common angiographic pattern, present in the majority of cases.
12 of 19 patients with obstructive CAD (63.2%) had three-vessel disease
4 patients (21.1%) had two-vessel disease
3 patients (15.8%) had single-vessel disease
Three-vessel disease was the predominant extent of obstructive CAD in this cohort
Results
Severe occlusive coronary lesions were present in more than half of patients with obstructive CAD.
10 of 19 patients with obstructive CAD (52.6%) had severe occlusive coronary lesions, defined as chronic total occlusions or subtotal stenoses
8 patients (42.1%) had at least one chronic total occlusion
5 patients (26.3%) had at least one subtotal stenosis
These findings indicate a high burden of severe coronary disease when obstructive CAD was present
Methods
The study cohort was predominantly male and middle-aged, with patients presenting with a newly diagnosed dilated cardiomyopathy phenotype of initially unknown etiology.
Total of 107 consecutive patients were included
Mean age was 55.4 ± 10.9 years
97 patients (90.7%) were male
All patients underwent first-time diagnostic invasive coronary angiography
Patients were categorized as having non-obstructive/no significant stenoses, single-vessel, two-vessel, or three-vessel disease
Conclusions
The authors conclude that obstructive epicardial CAD was uncommon in this selected angiography-referred cohort while underscoring the clinical role of coronary angiography when an ischemic or mixed etiology is clinically suspected.
Fewer than one in five patients had obstructive CAD (17.8%)
The study highlights that identification of obstructive CAD may influence etiologic classification, prognosis, and subsequent management
Real-world angiography-based data on prevalence and angiographic severity in this setting were noted to be limited, particularly in regional single-center cohorts
Findings were described as relevant to clinical decision-making regarding coronary angiography referral in DCM phenotype patients
What This Means
This research suggests that among patients who appeared to have dilated cardiomyopathy (a condition where the heart muscle weakens and the heart enlarges) and were sent for invasive coronary artery imaging, only about 1 in 6 (roughly 18%) actually had significant blockages in their heart arteries. The large majority — over 82% — did not have meaningful artery blockages, suggesting their heart condition was likely due to other causes such as viral infection, genetic factors, or other non-coronary reasons. The study included 107 patients, mostly middle-aged men, seen at a university hospital in Bulgaria over a 15-year period.
However, this research also suggests that when significant coronary blockages were found, they tended to be severe. Nearly two-thirds of those with blocked arteries had three-vessel disease, meaning all three major heart arteries were affected. More than half had very severe blockages, including complete artery occlusions (chronic total occlusions) or near-complete blockages (subtotal stenoses). This combination — relatively uncommon overall but severe when present — highlights how important it is to identify which patients with a weakened, enlarged heart actually have coronary artery disease as the underlying cause.
This research suggests that coronary angiography (an imaging procedure that visualizes heart artery blockages) remains a valuable diagnostic tool when doctors suspect that blocked arteries might be causing or contributing to a patient's heart failure, even though most patients with this presentation will ultimately be found to have non-coronary causes. Correctly identifying an ischemic (artery-blockage-related) cause can significantly change how a patient is treated and what their long-term outlook may be.
Yambolov S, Grigorov R, Nikolov N, Borisov I, Georgiev S. (2026). Prevalence and Angiographic Severity of Obstructive Coronary Artery Disease in Patients Presenting with a Dilated Cardiomyopathy Phenotype: A Retrospective Single-Center Cohort Study.. Medicina (Kaunas, Lithuania). https://doi.org/10.3390/medicina62081608