When is coronary angiography indicated for patients with heart failure?

Coronary angiography is an important diagnostic tool that helps assess the coronary arteries and is particularly indicated when patients with heart failure have a history of exertional angina or suspected ischemic left ventricular (LV) dysfunction. This is because ischemic heart disease can lead to heart failure, and identifying coronary artery obstruction can help guide treatment decisions.

In cases where patients report exertional angina, it suggests that their heart muscle may not be receiving adequate blood flow during increased activity, potentially due to narrowed or blocked arteries. If there is a suspicion of ischemic LV dysfunction, which means the heart's pumping ability is compromised due to inadequate blood supply, coronary angiography can reveal significant blockages that, once addressed, may improve heart function and symptoms.

This approach allows for targeted intervention, whether it be medical management, percutaneous coronary intervention, or coronary artery bypass graft surgery, thereby potentially improving outcomes in heart failure patients who exhibit these risk factors or symptoms.