201
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Duncker D, Bauersachs J, Hilfiker-Kleiner D, Veltmann C. Underestimated risk for life-threatening ventricular arrhythmias in newly diagnosed peripartum cardiomyopathy? Eur Heart J 2015; 36:1067-1068. [PMID: 26151075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
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202
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Stolfo D, Merlo M, Pinamonti B, Poli S, Gigli M, Barbati G, Fabris E, Di Lenarda A, Sinagra G. Early improvement of functional mitral regurgitation in patients with idiopathic dilated cardiomyopathy. Am J Cardiol 2015; 115:1137-43. [PMID: 25721482 DOI: 10.1016/j.amjcard.2015.01.549] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 01/13/2015] [Accepted: 01/13/2015] [Indexed: 01/26/2023]
Abstract
The aim of the study was to assess the clinical and prognostic impact of early functional mitral regurgitation (FMR) improvement on the outcome of patients with idiopathic dilated cardiomyopathy (IDC). The prevalence and prognostic role of FMR improvement, particularly at early follow-up, in patients with IDC are still unclear. From 1988 to 2009, we enrolled 470 patients with IDC with available FMR data at baseline and after 6 ± 2 months. According to the evolution of FMR, patients were classified into 3 groups: stable absent-mild FMR, early FMR improvement (downgrading from moderate-severe to absent-mild), and persistence/early development of moderate-severe FMR. At baseline, 177 of 470 patients (38%) had moderate-severe FMR. Patients with early FMR improvement had significantly better survival rate-free from heart transplant with respect to those with persistence/early development of moderate-severe FMR (93%, 81%, and 66% vs 91%, 64%, and 52% at 1, 6, and 12 years, respectively; p = 0.044). At 6-month follow-up multivariate analysis, FMR improvement was associated with better prognosis (hazard ratio 0.78, 95% confidence interval [CI] 0.64 to 0.96, p = 0.02); the other independent predictors were male gender, heart failure duration, and early re-evaluation of the New York Heart Association class and left ventricle systolic function. This model provided more accurate risk stratification compared with the baseline model (Net Reclassification Index 80% at 12 months and 41% at 72 months). In conclusion, in a large cohort of patients with IDC receiving optimal medical treatment, early improvement of FMR was frequent (53%) and emerged as a favorable independent prognostic factor with an incremental short- and long-term power compared with the baseline evaluation.
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Affiliation(s)
- Davide Stolfo
- Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
| | - Marco Merlo
- Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy
| | - Bruno Pinamonti
- Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy
| | - Stefano Poli
- Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy
| | - Marta Gigli
- Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy
| | - Giulia Barbati
- Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy; Cardiovascular Center, A.S.S.1, Trieste, Italy
| | - Enrico Fabris
- Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy
| | | | - Gianfranco Sinagra
- Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy
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203
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Hageman JR. Common signs and symptoms and unusual diagnoses: part 2. Pediatr Ann 2015; 44:104. [PMID: 25806727 DOI: 10.3928/00904481-20150313-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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204
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Aliku TO, Lubega S, Lwabi P. Resolution of dilated cardiomyopathy in an adolescent with change of a failing highly active antiretroviral drug therapy. Afr Health Sci 2015; 15:288-92. [PMID: 25834562 DOI: 10.4314/ahs.v15i1.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cardiovascular dysfunction is a recognized complication of HIV infection in children. Cardiac complications of HIV usually occur late in the course of the disease; they may be associated with drug therapy, and hence become more common as therapy and survival improve. Left ventricular (LV) dysfunction at baseline is a risk factor for death independent of the CD4 cell count, HIV viral load, and neurological disease. CLINICAL CASE We present the case of a 15 year old girl with HIV who developed left ventricular dysfunction while non-compliant on highly active antiretroviral therapy (HAART). She presented with features of heart failure over a course of two months. Her laboratory evaluation was significant for leucopenia with a low CD4 count, high viral load, elevated ESR and CRP. The ECG showed a sinus tachycardia with diffuse ST-T segment changes and LVH with strain. Initial echo revealed dilated left heart chambers with poor LV systolic function and a small pericardial effusion with the development of an LV thrombus on follow up echo evaluation. She was started on heart failure medicines and had anticoagulation for the LV thrombus. She received adherence counseling and her HAART regimen was changed. Six months after presentation she became asymptomatic with higher CD4 counts and a normal LV size and function on echo. CONCLUSION Immunological recovery following a switch of a failing or potentially cardiotoxic HAART in addition to improved HAART adherence may result in resolution of left ventricular dysfunction. Early and regular cardiology evaluation may improve outcomes in these patients.
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Affiliation(s)
- Twalib Olega Aliku
- Department of Paediatrics and Child Health, Gulu University ; Uganda Heart Institute, Mulago Hospital Complex
| | | | - Peter Lwabi
- Uganda Heart Institute, Mulago Hospital Complex
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205
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Bänsch D. [Risk stratification of sudden cardiac death in dilated cardiomyopathy. Programmed ventricular stimulation]. Herzschrittmacherther Elektrophysiol 2015; 26:8-11. [PMID: 25693482 DOI: 10.1007/s00399-015-0350-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 01/26/2015] [Indexed: 06/04/2023]
Abstract
There is a strong correlation between clinical presentation and results of the electrophysiological study (EPS) in patients with dilated cardiomyopathy. Patients with spontaneous ventricular tachycardia (VT) or syncope often have inducible VT in contrast to patients who have no history of arrhythmias or syncope. Therefore, the EPS is rather not useful for risk stratification but for planning of an adjuvant antiarrhythmic or ablation therapy. This is also true for patients with frequent ventricular extrasystole or nonsustained VT in whom VT may aggravate heart failure. An EP study may still be useful to differentiate between syncope of bradycardic or tachycardic origin.
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Affiliation(s)
- Dietmar Bänsch
- Herzzentrum, Uniklinik Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland,
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206
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Rana G, Shih J, Kakouros N. Percutaneous transcatheter balloon valvuloplasty for bioprosthetic tricuspid valve stenosis in a patient with orthotopic heart transplant. J Invasive Cardiol 2015; 27:E40-E41. [PMID: 25740974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 47-year-old man with history of familial cardiomyopathy and orthotopic heart transplant at the age of 34 years presented severe tricuspid stenosis (TS) with a mean transvalvular gradient of 10 mm Hg. The patient opted against tricuspid valve replacement and was offered percutaneous transcatheter tricuspid balloon valvuloplasty (PTTBV). To the best of our knowledge, this is the first report of a PTTBV in an orthotopic allograft, and demonstrates excellent clinical outcome at 1 year.
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Affiliation(s)
- Gaurav Rana
- Division of Cardiology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 USA.
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207
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Trembovetskaya EM, Knyshov GV, Zaharova VP, Rudenko KV. [Dilated cardiomyopathy: the role of left branch of atrioventricular bundle block in left ventricular walls longitudinal strain indices change]. Klin Khir 2015:23-25. [PMID: 26072537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Activity of the heart is assured by the myocardium motion with a composite path, which can be described with various quantitative indices, in particular the strain ones. The invention and implementation into clinical practice the "Speckle Tracking" ultrasonic technology, based on the two-dimensional echocardiography, allows to study of normal myocardium function as well as its functioning in various hart lesions, in particular, dilated cardiomyopathy (DCMP). Peculiarities of the features of longitudinal strain parameters of left ventricular (LV) walls in patients with DCMP, according to the occurrence of the total left branch of atrioventricular bundle block were studied. In DCMP the indices of longitudinal myocardial strain of the LV were strongly decreasing with the augmenting of heart failure signs. The appearance of the total left branch of atrioventricular bundle block, manifested by the total decrease of amplitude of longitudinal strain of the lateral and posterior walls of the LV, led to the augmenting of mitral regurgitation (up to 2+) and increase of the pulmonary hypertension, augmenting of circulatory deficiency signs.
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208
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Parnham S, Selvanayagam JB, Haan E, Heddle W, De Pasquale CG. Lamin A/C mutation: An easily missed opportunity. Int J Cardiol 2015; 181:48-9. [PMID: 25481314 DOI: 10.1016/j.ijcard.2014.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 12/01/2014] [Indexed: 11/18/2022]
MESH Headings
- Atrioventricular Block/diagnosis
- Atrioventricular Block/etiology
- Cardiomyopathy, Dilated/complications
- Cardiomyopathy, Dilated/diagnosis
- Cardiomyopathy, Dilated/genetics
- Cardiomyopathy, Dilated/therapy
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Disease Management
- Echocardiography/methods
- Electrocardiography, Ambulatory/methods
- Humans
- Lamin Type A/genetics
- Male
- Middle Aged
- Mutation
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Affiliation(s)
- Susie Parnham
- Department of Cardiovascular Medicine, Flinders Medical Centre, Australia; School of Medicine, Flinders University, Australia.
| | - Joseph B Selvanayagam
- Department of Cardiovascular Medicine, Flinders Medical Centre, Australia; School of Medicine, Flinders University, Australia
| | - Eric Haan
- South Australian Clinical Genetics Service, SA Pathology (at Women's and Children's Hospital), North Adelaide, Australia; School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia
| | - William Heddle
- Department of Cardiovascular Medicine, Flinders Medical Centre, Australia; School of Medicine, Flinders University, Australia
| | - Carmine G De Pasquale
- Department of Cardiovascular Medicine, Flinders Medical Centre, Australia; School of Medicine, Flinders University, Australia
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209
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Wang B, Wang Y. Acute coronary syndrome caused by left main coronary artery compression between the aortic root and massive dilation of the left atrium. Can J Cardiol 2015; 31:227.e3-5. [PMID: 25661561 DOI: 10.1016/j.cjca.2014.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 10/25/2014] [Accepted: 10/31/2014] [Indexed: 11/19/2022] Open
Abstract
Left main compression by pulmonary artery dilation has been reported previously. Percutaneous or surgical interventions are treatment options. We report on a 78-year-old man with exertional chest pain and dyspnea. Coronary angiography revealed significant ostial left main artery stenosis. Intravascular ultrasound showed no atherosclerotic plaque but did reveal a rhythmic external compression between the aortic root and another lucent structure. The patient underwent successful stenting of the lesion. Subsequently, 64-slice multidetector coronary computed tomography found the source of compression to be an enlarged left atrium. The patient remains free of coronary insufficiency after 18 months of follow-up.
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Affiliation(s)
- Bin Wang
- Department of Cardiology, Xiamen Heart Center, Xiamen University, Xiamen, People's Republic of China
| | - Yan Wang
- Department of Cardiology, Xiamen Heart Center, Xiamen University, Xiamen, People's Republic of China.
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210
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Hashimoto M, Sakaguchi H, Sadanaga M. [Anesthetic Management for Endoscopic Sinus Surgery in a Patient with Transplanted Heart--A Case Report]. Masui 2015; 64:160-163. [PMID: 26121809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 19-year-old male patient with transplanted heart received endoscopic sinus surgery. He was with X-linked dilated cardiomyopathy, and was one year after the transplantation. Preanesthetic study showed lactate dehydrogenase elevation estimated to have derived from striated muscle. Heart function was normal, and other abnormal findings were not revealed. Total intravenous anesthesia was performed with propofol target controlled infusion and remifentanil. Rocuronium was administered only for oro-tracheal ntubation. After the operation, train-of-four ratio was 95%, and he awoke from anesthesia smoothly. We did not use atropine, neostigmine or sugammadex to reverse neuromuscular blockade. No inotropic agent was administered. He was discharged from the hospital 5 days after the operation without any complications. We used usual anesthetic management but we had to be careful about both denervated heart and myopathy.
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211
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Beadle RM, Williams LK, Kuehl M, Bowater S, Abozguia K, Leyva F, Yousef Z, Wagenmakers AJM, Thies F, Horowitz J, Frenneaux MP. Improvement in cardiac energetics by perhexiline in heart failure due to dilated cardiomyopathy. JACC Heart Fail 2015; 3:202-11. [PMID: 25650370 DOI: 10.1016/j.jchf.2014.09.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/05/2014] [Accepted: 09/19/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to determine whether short-term treatment with perhexiline improves cardiac energetics, left ventricular function, and symptoms of heart failure by altering cardiac substrate utilization. BACKGROUND Perhexiline improves exercise capacity and left ventricular ejection fraction (LVEF) in patients with heart failure (HF). (31)P cardiac magnetic resonance spectroscopy can be used to quantify the myocardial phosphocreatine/adenosine triphosphate ratio. Because improvement of HF syndrome can improve cardiac energetics secondarily, we investigated the effects of short-term perhexiline therapy. METHODS Patients with systolic HF of nonischemic etiology (n = 50, 62 ± 1.8 years of age, New York Heart Association functional class II to IV, LVEF: 27.0 ± 1.44%) were randomized to receive perhexiline 200 mg or placebo for 1 month in a double-blind fashion. Clinical assessment, echocardiography, and (31)P cardiac magnetic resonance spectroscopy were performed at baseline and after 1 month. A substudy of 22 patients also underwent cross-heart blood sampling at completion of the study to quantify metabolite utilization. RESULTS Perhexiline therapy was associated with a 30% increase in the phosphocreatine/adenosine triphosphate ratio (from 1.16 ± 0.39 to 1.51 ± 0.51; p < 0.001) versus a 3% decrease with placebo (from 1.36 ± 0.31 to 1.34 ± 0.31; p = 0.37). Perhexiline therapy also led to an improvement in New York Heart Association functional class compared with placebo (p = 0.036). Short-term perhexiline therapy did not change LVEF. Cross-heart measures of cardiac substrate uptake and respiratory exchange ratio (which reflects the ratio of substrates used) did not differ between patients who received perhexiline versus placebo. CONCLUSIONS Perhexiline improves cardiac energetics and symptom status with no evidence of altered cardiac substrate utilization. No change in LVEF is seen at this early stage. (Metabolic Manipulation in Chronic Heart Failure; NCT00841139).
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Affiliation(s)
- Roger M Beadle
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, Scotland
| | - Lynne K Williams
- Department of Cardiology, Toronto General Hospital, Toronto, Ontario, Canada
| | - Michael Kuehl
- Department of Cardiovascular Medicine, University of Birmingham, Birmingham, England
| | - Sarah Bowater
- Department of Cardiovascular Medicine, University of Birmingham, Birmingham, England
| | - Khalid Abozguia
- Department of Cardiovascular Medicine, University of Birmingham, Birmingham, England
| | - Francisco Leyva
- Department of Cardiovascular Medicine, University of Birmingham, Birmingham, England
| | - Zaheer Yousef
- Department of Cardiology, University Hospital of Wales, Cardiff, Wales
| | - Anton J M Wagenmakers
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, England
| | - Frank Thies
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, Scotland
| | - John Horowitz
- Department of Cardiology and Pharmacology, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - Michael P Frenneaux
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, Scotland.
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212
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Demir OM, Paschou SA, Ellis HC, Fitzpatrick M, Kalogeropoulos AS, Davies A, Thompson J, Davies SW, Grapsa J. Reversal of dilated cardiomyopathy after glucagonoma excision. Hormones (Athens) 2015; 14:172-3. [PMID: 25553769 DOI: 10.14310/horm.2002.1557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 08/01/2015] [Indexed: 11/20/2022]
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213
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Lorenzo N, Restrepo JA, Aguilera MC, Rodriguez D, Aguilar R. Massive Intraventricular Thrombosis in a Young Woman with Idiopathic Dilated Cardiomyopathy. Arq Bras Cardiol 2015; 105:647-8. [PMID: 26761373 PMCID: PMC4693670 DOI: 10.5935/abc.20150131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Natalia Lorenzo
- Hospital Universitario Infanta Cristina, Madri -
Espanha
- Mailing Address: Natalia Lorenzo, Avenida 9 de Junio, 2,
Parla, Postal Code 28981, Madri - Espanha. E-mail:
| | | | | | | | - Rio Aguilar
- Hospital Universitario De La Princesa, Madri -
Espanha
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214
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Yagi H, Hatano M, Takeda N, Harada S, Suzuki Y, Taniguchi Y, Shintani Y, Morita H, Kanamori N, Aoyama T, Watanabe M, Manabe I, Akazawa H, Kinugawa K, Komuro I. Congenital Contractural Arachnodactyly without FBN1 or FBN2 Gene Mutations Complicated by Dilated Cardiomyopathy. Intern Med 2015; 54:1237-41. [PMID: 25986263 DOI: 10.2169/internalmedicine.54.4280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Congenital contractural arachnodactyly (CCA) is a rare connective tissue disorder characterized by marfanoid habitus with camptodactyly. However, cardiac features have rarely been documented in adults. We herein report a sporadic case of CCA in a 20-year-old woman who developed decompensated dilated cardiomyopathy. The patient did not have any mutations in the FBN1 or FBN2 genes, which are most commonly associated with Marfan syndrome and CCA, respectively. Although whether these two diseases are caused by a mutation(s) in the same gene or two different genes remains unknown, this case provides new clinical insight into the cardiovascular management of CCA.
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Affiliation(s)
- Hiroki Yagi
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Japan
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215
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Ituk US, Habib AS, Polin CM, Allen TK. Anesthetic management and outcomes of parturients with dilated cardiomyopathy in an academic centre. Can J Anaesth 2014; 62:278-88. [PMID: 25501493 DOI: 10.1007/s12630-014-0290-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 12/02/2014] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study examines the peripartum anesthetic management and outcomes of women with dilated cardiomyopathy in a large university medical centre over a seven-year period. PRINCIPAL FINDINGS Twenty-five women were included in this series, 18 with a new diagnosis of cardiomyopathy and seven with a history of cardiomyopathy. Sixteen patients (64%) identified themselves as African American, seven (28%) were Caucasian, and two patients (8%) were Hispanic. The median (range) gestational age at the time of a new diagnosis of cardiomyopathy was 29 (7-38) weeks. Eight women (32%) had New York Heart Association class III/IV symptoms at the time of delivery or in the immediate postpartum period. A multidisciplinary team of obstetricians, anesthesiologists, cardiologists, and pediatricians were involved in the care of these women. The median (range) gestational age at the time of delivery was 33.5 (30-40) weeks. There were nine vaginal deliveries and 15 operative deliveries. One patient had fetal loss at 19 weeks gestation. Twelve women had labour induced with an intravenous infusion of oxytocin at a rate of 0.001-0.02 IU·min(-1). An oxytocin infusion at a variable rate with a maximum dose of 0.05 IU·min(-1) was administered after vaginal delivery to maintain uterine tone. Epidural analgesia was initiated prior to induction of labour or in the latent phase of labour. Seven Cesarean deliveries were performed under combined spinal-epidural anesthesia, five were performed under epidural anesthesia, and three women had general anesthesia. Oxytocin was administered via an intravenous infusion at a rate of 0.05-0.2 IU·min(-1) after operative delivery. One patient had a cardiac arrest on induction of general anesthesia and was successfully resuscitated. There were no maternal or neonatal deaths. Ten women were followed up at our institution and at six months postpartum; 50% of these patients were still symptomatic. CONCLUSION We report favourable outcomes in 25 pregnant women with dilated cardiomyopathy who were managed by a multidisciplinary team.
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MESH Headings
- Academic Medical Centers
- Adult
- Anesthesia, Epidural
- Anesthesia, General
- Anesthesia, Obstetrical/methods
- Anesthesia, Spinal
- Cardiomyopathy, Dilated/complications
- Delivery, Obstetric/methods
- Delivery, Obstetric/statistics & numerical data
- Female
- Fetal Death
- Heart Arrest
- Humans
- Labor, Obstetric
- Outcome and Process Assessment, Health Care/statistics & numerical data
- Oxytocics/administration & dosage
- Oxytocin/administration & dosage
- Pregnancy
- Pregnancy Complications, Cardiovascular
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Affiliation(s)
- Unyime S Ituk
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA,
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216
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Chen DY, Chen YM, Tzang BS, Lan JL, Hsu TC. Th17-related cytokines in systemic lupus erythematosus patients with dilated cardiomyopathies: a possible linkage to parvovirus B19 infection. PLoS One 2014; 9:e113889. [PMID: 25462010 PMCID: PMC4252071 DOI: 10.1371/journal.pone.0113889] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 10/31/2014] [Indexed: 12/11/2022] Open
Abstract
Dilated cardiomyopathies (DCM) are a major cause of mortality in patients with systemic lupus erythematosus (SLE). Immune responses induced by human parvovirus B19 (B19) are considered an important pathogenic mechanism in myocarditis or DCM. However, little is known about Th17-related cytokines in SLE patients with DCM about the linkage with B19 infection. IgM and IgG against B19 viral protein, and serum levels of Th17-related cytokines were determined using ELISA in eight SLE patients with DCM and six patients with valvular heart disease (VHD). Humoral responses of anti-B19-VP1u and anti-B19-NS1 antibody were assessed using Western blot and B19 DNA was detected by nested Polymerase Chain Reaction (PCR). Levels of interleukin (IL)-17, IL-6, IL-1β, and tumor necrosis factor (TNF)-α were significantly higher in SLE patients with DCM (mean ± SEM, 390.99±125.48 pg/ml, 370.24±114.09 pg/ml, 36.01±16.90 pg/ml, and 183.84±82.94 pg/ml, respectively) compared to healthy controls (51.32±3.04 pg/ml, p<0.001; 36.88±6.64 pg/ml, p<0.001; 5.39±0.62 pg/ml, p<0.005; and 82.13±2.42 pg/ml, p<0.005, respectively). Levels of IL-17 and IL-6 were higher in SLE patients with DCM versus those with VHD (both p<0.01). Five (62.5%) of DCM patients had detectable anti-B19-NS1 IgG and four (50.0%) of them had anti-B19-VP1u IgG, whereas only one (16.7%) of VHD patients had detectable anti-B19-NS1 IgG and anti-B19-VP1u IgG. Serum levels of IL-17, IL-6 and IL-1β were markedly higher in SLE patients with anti-B19-VP1u IgG and anti-B19-NS1 IgG compared to those without anti-B19-VP1u IgG or anti-B19-NS1 IgG, respectively. These suggest a potential association of B19 with DCM and Th17-related cytokines implicated in the pathogenesis of DCM in SLE patients.
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Affiliation(s)
- Der-Yuan Chen
- Division of Allergy, Immunology and Rheumatology, Department of Medical Education, Taichung Veterans General Hospital, Taichung City, Taiwan
- Faculty of Medicine, National Yang Ming University, Taipei, Taiwan
- Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
- Institute of Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan
| | - Yi-Ming Chen
- Division of Allergy, Immunology and Rheumatology, Department of Medical Education, Taichung Veterans General Hospital, Taichung City, Taiwan
- Faculty of Medicine, National Yang Ming University, Taipei, Taiwan
- Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Bor-Show Tzang
- Institute of Biochemistry and Biotechnology, Chung Shan Medical University, Taichung, Taiwan
- Department of Biochemistry, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Immunology Research Center, Chung Shan Medical University, Taichung, Taiwan
- Clinical Laboratory, Chung Shan Medical University Hospital, Taichung, Taiwan
- * E-mail: (BST); (TCH)
| | - Joung-Liang Lan
- Division of Immunology and Rheumatology, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Tsai-Ching Hsu
- Institute of Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan
- Immunology Research Center, Chung Shan Medical University, Taichung, Taiwan
- Clinical Laboratory, Chung Shan Medical University Hospital, Taichung, Taiwan
- * E-mail: (BST); (TCH)
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Maiouak S, Zaghba N, Benjelloun H, Hilali S, Yassine N, Bakhatar A, Bahlaoui A. [Peripartum cardiomyopathy revealed by multifocal tuberculosis]. Rev Pneumol Clin 2014; 70:382-385. [PMID: 25457219 DOI: 10.1016/j.pneumo.2014.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 08/03/2014] [Accepted: 08/17/2014] [Indexed: 06/04/2023]
Affiliation(s)
- S Maiouak
- Service des maladies respiratoires, CHU Ibn Rochd, Casablanca, Maroc.
| | - N Zaghba
- Service des maladies respiratoires, CHU Ibn Rochd, Casablanca, Maroc
| | - H Benjelloun
- Service des maladies respiratoires, CHU Ibn Rochd, Casablanca, Maroc
| | - S Hilali
- Service des maladies respiratoires, CHU Ibn Rochd, Casablanca, Maroc
| | - N Yassine
- Service des maladies respiratoires, CHU Ibn Rochd, Casablanca, Maroc
| | - A Bakhatar
- Service des maladies respiratoires, CHU Ibn Rochd, Casablanca, Maroc
| | - A Bahlaoui
- Service des maladies respiratoires, CHU Ibn Rochd, Casablanca, Maroc
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218
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Affiliation(s)
- S W Dubrey
- From the Department of Cardiology, Department of Haematology, Hillingdon Hospital, Pield Heath Road, Uxbridge, Middlesex, UB8 3NN and Department of Radiology, Harefield Hospital, Hill End Road, Harefield, Middlesex, UB9 6JH, UK
| | - G Rosser
- From the Department of Cardiology, Department of Haematology, Hillingdon Hospital, Pield Heath Road, Uxbridge, Middlesex, UB8 3NN and Department of Radiology, Harefield Hospital, Hill End Road, Harefield, Middlesex, UB9 6JH, UK
| | - M T Dahdal
- From the Department of Cardiology, Department of Haematology, Hillingdon Hospital, Pield Heath Road, Uxbridge, Middlesex, UB8 3NN and Department of Radiology, Harefield Hospital, Hill End Road, Harefield, Middlesex, UB9 6JH, UK
| | - K Patel
- From the Department of Cardiology, Department of Haematology, Hillingdon Hospital, Pield Heath Road, Uxbridge, Middlesex, UB8 3NN and Department of Radiology, Harefield Hospital, Hill End Road, Harefield, Middlesex, UB9 6JH, UK
| | - J Wong
- From the Department of Cardiology, Department of Haematology, Hillingdon Hospital, Pield Heath Road, Uxbridge, Middlesex, UB8 3NN and Department of Radiology, Harefield Hospital, Hill End Road, Harefield, Middlesex, UB9 6JH, UK
| | - R Grocott-Mason
- From the Department of Cardiology, Department of Haematology, Hillingdon Hospital, Pield Heath Road, Uxbridge, Middlesex, UB8 3NN and Department of Radiology, Harefield Hospital, Hill End Road, Harefield, Middlesex, UB9 6JH, UK
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219
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Abdullah OM, Drakos SG, Diakos NA, Wever-Pinzon O, Kfoury AG, Stehlik J, Selzman CH, Reid BB, Brunisholz K, Verma DR, Myrick C, Sachse FB, Li DY, Hsu EW. Characterization of diffuse fibrosis in the failing human heart via diffusion tensor imaging and quantitative histological validation. NMR Biomed 2014; 27:1378-86. [PMID: 25200106 PMCID: PMC4215542 DOI: 10.1002/nbm.3200] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 07/09/2014] [Accepted: 08/15/2014] [Indexed: 05/16/2023]
Abstract
Non-invasive imaging techniques are highly desirable as an alternative to conventional biopsy for the characterization of the remodeling of tissues associated with disease progression, including end-stage heart failure. Cardiac diffusion tensor imaging (DTI) has become an established method for the characterization of myocardial microstructure. However, the relationships between diffuse myocardial fibrosis, which is a key biomarker for staging and treatment planning of the failing heart, and measured DTI parameters have yet to be investigated systematically. In this study, DTI was performed on left ventricular specimens collected from patients with chronic end-stage heart failure as a result of idiopathic dilated cardiomyopathy (n = 14) and from normal donors (n = 5). Scalar DTI parameters, including fractional anisotropy (FA) and mean (MD), primary (D1 ), secondary (D2 ) and tertiary (D3 ) diffusivities, were correlated with collagen content measured by digital microscopy. Compared with hearts from normal subjects, the FA in failing hearts decreased by 22%, whereas the MD, D2 and D3 increased by 12%, 14% and 24%, respectively (P < 0.01). No significant change was detected for D1 between the two groups. Furthermore, significant correlation was observed between the DTI scalar indices and quantitative histological measurements of collagen (i.e. fibrosis). Pearson's correlation coefficients (r) between collagen content and FA, MD, D2 and D3 were -0.51, 0.59, 0.56 and 0.62 (P < 0.05), respectively. The correlation between D1 and collagen content was not significant (r = 0.46, P = 0.05). Computational modeling analysis indicated that the behaviors of the DTI parameters as a function of the degree of fibrosis were well explained by compartmental exchange between myocardial and collagenous tissues. Combined, these findings suggest that scalar DTI parameters can be used as metrics for the non-invasive assessment of diffuse fibrosis in failing hearts.
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Affiliation(s)
| | - Stavros G. Drakos
- Molecular Medicine Program, University of Utah
- UTAH Cardiac Transplant Program (University of Utah Hospital, Intermountain Medical Center, Salt Lake Veterans Affairs Medical Center)
| | | | - Omar Wever-Pinzon
- UTAH Cardiac Transplant Program (University of Utah Hospital, Intermountain Medical Center, Salt Lake Veterans Affairs Medical Center)
| | - Abdallah G. Kfoury
- UTAH Cardiac Transplant Program (University of Utah Hospital, Intermountain Medical Center, Salt Lake Veterans Affairs Medical Center)
| | - Josef Stehlik
- UTAH Cardiac Transplant Program (University of Utah Hospital, Intermountain Medical Center, Salt Lake Veterans Affairs Medical Center)
| | - Craig H. Selzman
- UTAH Cardiac Transplant Program (University of Utah Hospital, Intermountain Medical Center, Salt Lake Veterans Affairs Medical Center)
| | - Bruce B. Reid
- UTAH Cardiac Transplant Program (University of Utah Hospital, Intermountain Medical Center, Salt Lake Veterans Affairs Medical Center)
| | - Kim Brunisholz
- UTAH Cardiac Transplant Program (University of Utah Hospital, Intermountain Medical Center, Salt Lake Veterans Affairs Medical Center)
| | - Divya Ratan Verma
- UTAH Cardiac Transplant Program (University of Utah Hospital, Intermountain Medical Center, Salt Lake Veterans Affairs Medical Center)
| | | | - Frank B. Sachse
- Department of Bioengineering, University of Utah
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah
| | - Dean Y. Li
- Molecular Medicine Program, University of Utah
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220
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Takamine S, Fujiwara S, Shigeru M, Ito T, Kawai H, Shiotani H, Hirata KI. Relationship of decreased accumulation of (99m)Tc-tetrofosmin on myocardial single-photon emission computed tomography images between QRS duration in dilated cardiomyopathy patient with left bundle branch block. J Nucl Cardiol 2014; 21:1023-8. [PMID: 24942610 DOI: 10.1007/s12350-014-9923-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 05/09/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to clarify the relationship between severity of conduction delay in the left ventricle and myocardial uptake of (99m)Tc-tetrofosmin (TF) in dilated cardiomyopathy (DCM) patients with left bundle branch block (LBBB). METHODS AND RESULTS Thirty-two DCM patients with LBBB underwent electrocardiography and (99m)Tc-TF myocardial single-photon emission computed tomography (SPECT). SPECT images were acquired at 30 min (early images) and 3 h (late images) after injection. We calculated the total defect score (TDS) using a 20-segment model with a 5-point scoring system. The TDS in early and late images was defined as the summed early score (SES) and summed late score (SLS), respectively. On early images, 29 of 32 patients (91%) had decreased tracer uptake in the septum. All patients showed a decreased tracer uptake in the septum on late images. A significant correlation was observed between TDS (both SES and SLS) and QRS duration, with SLS showing an excellent correlation (SES: r = 0.554, P < 0.001; SLS: r = 0.779, P < 0.0001). CONCLUSIONS These findings suggest that in DCM patients with LBBB, hypoperfusion and myocardial damage in the septum might occur in accordance with an increase in the QRS duration.
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Affiliation(s)
- Sachiko Takamine
- Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan,
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221
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Deo SV, Rababa'h A, Altarabsheh SE, Lim JY, Cho YH, Park SJ. Statin therapy improves long-term survival in non-ischaemic cardiomyopathy: a pooled analysis of 4500 patients. Heart Lung Circ 2014; 23:985-7. [PMID: 24851827 DOI: 10.1016/j.hlc.2014.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 04/02/2014] [Accepted: 04/05/2014] [Indexed: 02/07/2023]
Abstract
Statin therapy has demonstrated a beneficial effect in patients with chronic heart failure. While the majority of patients with ischaemic cardiomyopathy are prescribed these drugs, studies have demonstrated that less than one fifth of patients with dilated cardiomyopathy are on regular statin therapy. We have performed a meta-analysis of 4500 patients from six studies (four randomised controlled trials). Our results demonstrate that statin therapy significantly improves long-term survival in patients with non-ischaemic heart failure {Hazard ratio for mortality 0.45 (0.33-0.62); p<0.0001; I(2)=41%; p-value for heterogeneity=0.13}.
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Affiliation(s)
- Salil V Deo
- Adventist Wockhardt Heart Institute, Surat Gujarat India.
| | - Abeer Rababa'h
- Jordan University of Science and Technology, Irbid Jordan
| | | | | | - Yang Hyun Cho
- Samsung Medical Center, Sungkyunkwan University of Medical Sciences, Seoul, South Korea
| | - Soon J Park
- Case Medical Center, Case Western Reserve University Cleveland OH USA
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222
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Hatanaka N, Ueda T. [Removal of biventricular thrombi for dilated cardiomyopathy in a patient with acute heart failure]. Kyobu Geka 2014; 67:895-898. [PMID: 25201366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We report a rare case of a 49-year-old man with biventricular thrombi associated with idiopathic dilated cardiomyopathy (DCM). The patient was admitted with congestive heart failure and pneumonia. Echocardiography revealed mobile "ball-like" biventricular thrombi associated with significantly impaired left ventricular function and severe mitral/tricuspid valve regurgitation. The biventricular thrombi were removed and subsequently, a mitral annuloplasty, as well as papillary muscle approximation and tricuspid annuloplasty were performed. The postoperative course has been uneventful over a period of 2 years and neither thromboembolic events nor recurrence of congestive heart failure has been observed.
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Affiliation(s)
- Noriyuki Hatanaka
- Department of Cardiovascular Surgery, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
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223
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Bell SP, Adkisson DW, Lawson MA, Wang L, Ooi H, Sawyer DB, Kronenberg MW. Antifailure therapy including spironolactone improves left ventricular energy supply-demand relations in nonischemic dilated cardiomyopathy. J Am Heart Assoc 2014; 3:e000883. [PMID: 25164945 PMCID: PMC4310370 DOI: 10.1161/jaha.114.000883] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 08/04/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND Left ventricular (LV) energy supply-demand imbalance is postulated to cause "energy starvation" and contribute to heart failure (HF) in nonischemic dilated cardiomyopathy (NIDCM). Using cardiac magnetic resonance (CMR) and [(11)C] acetate positron emission tomography (PET), we evaluated LV perfusion and oxidative metabolism in NIDCM and the effects of spironolactone on LV supply-demand relations. METHODS AND RESULTS Twelve patients with NIDCM underwent CMR and PET at baseline and after ≥6 months of spironolactone therapy added to a standard HF regimen. The myocardial perfusion reserve index (MPRI) was calculated after gadolinium injection during adenosine, as compared to rest. The monoexponential clearance rate of [(11)C] acetate (kmono) was used to calculate the work metabolic index (WMI), an index of LV mechanical efficiency, and kmono/RPP (rate-pressure product), an index of energy supply/demand. At baseline, the subendocardium was hypoperfused versus the subepicardium (median MPRI, 1.63 vs. 1.80; P<0.001), but improved to 1.80 (P<0.001) after spironolactone. The WMI increased (P=0.001), as did kmono/RPP (P=0.003). These improvements were associated with reverse remodeling, increased LV ejection fraction, and decreases in LV mass and systolic wall stress (all P<0.002). CONCLUSIONS NIDCM is associated with subendocardial hypoperfusion and impaired myocardial oxidative metabolism, consistent with energy starvation. Antifailure therapy improves parameters of energy starvation and is associated with augmented LV performance. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov/ Unique identifier: ID NCT00574119.
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Affiliation(s)
- Susan P. Bell
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, VA Tennessee Valley Healthcare System, Nashville, TN (S.P.B., D.W.A., M.A.L., H.O., D.B.S., M.W.K.)
| | - Douglas W. Adkisson
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, VA Tennessee Valley Healthcare System, Nashville, TN (S.P.B., D.W.A., M.A.L., H.O., D.B.S., M.W.K.)
| | - Mark A. Lawson
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, VA Tennessee Valley Healthcare System, Nashville, TN (S.P.B., D.W.A., M.A.L., H.O., D.B.S., M.W.K.)
| | - Li Wang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN (L.W.)
| | - Henry Ooi
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, VA Tennessee Valley Healthcare System, Nashville, TN (S.P.B., D.W.A., M.A.L., H.O., D.B.S., M.W.K.)
- Cardiology Section, VA Tennessee Valley Healthcare System, Nashville, TN (H.O., M.W.K.)
| | - Douglas B. Sawyer
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, VA Tennessee Valley Healthcare System, Nashville, TN (S.P.B., D.W.A., M.A.L., H.O., D.B.S., M.W.K.)
| | - Marvin W. Kronenberg
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, VA Tennessee Valley Healthcare System, Nashville, TN (S.P.B., D.W.A., M.A.L., H.O., D.B.S., M.W.K.)
- Cardiology Section, VA Tennessee Valley Healthcare System, Nashville, TN (H.O., M.W.K.)
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224
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Strecker T, Rösch J, Weyand M, Agaimy A. Pathological findings in cardiac apex removed during implantation of left ventricular assist devices (LVAD) are non-specific: 13-year-experience at a German Heart Center. Int J Clin Exp Pathol 2014; 7:5549-5556. [PMID: 25337196 PMCID: PMC4203167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 08/21/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND AIM Ventricular assist devices (VAD) have become an established therapy for patients with end-stage heart failure. The two main reasons for this development are the shortage of appropriate donor organs and the increasing number of patients waiting for heart transplantation (HTX). Furthermore, the enormous advances in the technical equipment and the rising clinical experience have improved the implantation technique, the durability and the long-term patient outcomes. METHODS We reviewed all cases of left ventricular assist device (LVAD) implantation at our Erlangen Heart Center during January 2000-July 2013. The main aim of this study was to analyze the underlying pathology from the cardiac apex removed during the implantation. From all patients, we created a follow-up, analyzed the pathological features with the clinical diagnoses and described the overall outcome. RESULTS VAD implantation was performed in 266 cases at our center in the last 13 years (2.2% of the total of 12254 cardiac surgical operations in that period). From these patients, 223 underwent LVAD or biventricular (BVAD) implantation; the remaining received a right (RVAD) implantation. The most frequent underlying clinical diagnoses were dilated (n = 84, 37.7%, DCM) or ischemic (n = 61, 27.4%, ICM) cardiomyopathy. The pathological findings in the apex biopsy were generally non-specific and showed variable interstitial myocardial fibrosis with evidence of fibre loss, fatty degeneration and variable irregular atrophy of muscle fibres, consistent with dilated and ischemic cardiomyopathies as the most frequent causes of heart failure in these patients. Only a few cases showed other specific features such as myocarditis and AL-amyloidosis. CONCLUSIONS Pathological findings in cardiac apex removed during LVAD implantation are rather non-specific and they generally reflect the late stage or consequences of chronic myocardial damage in cases of dilated or ischemic cardiomyopathies. Variable patchy chronic inflammatory changes may be observed in cardiomyopathies as a non-specific reaction caused by myocardial fiber damage and should not lead to misinterpretation as evidence of myocarditis or revision of original diagnosis.
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Affiliation(s)
- Thomas Strecker
- Center of Cardiac Surgery, Friedrich-Alexander-University Erlangen-NurembergErlangen, Germany
| | - Johannes Rösch
- Center of Cardiac Surgery, Friedrich-Alexander-University Erlangen-NurembergErlangen, Germany
| | - Michael Weyand
- Center of Cardiac Surgery, Friedrich-Alexander-University Erlangen-NurembergErlangen, Germany
| | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander-University Erlangen-NurembergErlangen, Germany
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225
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Zakliaz'minskaia EV, Chapurnykh AV, Voronina TS, Van EI, Shestak AG, Saber S, Dzemeshkevich SL. [Dilated cardiomyopathy caused by p.E446K mutation in SCN5A gene]. Kardiologiia 2014; 54:92-6. [PMID: 25102755 DOI: 10.18565/cardio.2014.3.92-96] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Dilated cardiomyopathy (DCM) is myocardial disorder characterized by progressive heart chambers enlargement and impairment of myocardial contractility. This disorder is the most common cause of advanced heart failure requiring the heart transplantation. The prevalence of the disease is 36.5 per 100 000 in population. About 20-30% of cases are familial. Disease is genetically heterogenous, there more than 100 genes when mutated can give rise a DCM. In 2004, the role of SCN5A gene mutations was shown in origin of DCM with cardiac conduction defects and arrhythmias. In this work we present a clinical case of dilated cardiomyopathy with cardiac arrhythmias and p.E446K mutation in SCN5A gene. We have observed DCM with mild left ventricular hypertrophy, progressive AV block, atrial fibrillation and congenital heart defect (atrium septal defect) in two generations. The congenital heart defect did not co-segregate with SCN5A mutation and DCM.
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MESH Headings
- Atrial Fibrillation/complications
- Atrial Fibrillation/diagnosis
- Atrial Fibrillation/genetics
- Atrial Fibrillation/physiopathology
- Atrial Fibrillation/therapy
- Atrioventricular Block/complications
- Atrioventricular Block/diagnosis
- Atrioventricular Block/genetics
- Atrioventricular Block/physiopathology
- Atrioventricular Block/therapy
- Cardiac Pacing, Artificial/methods
- Cardiac Surgical Procedures/methods
- Cardiomyopathy, Dilated/complications
- Cardiomyopathy, Dilated/diagnosis
- Cardiomyopathy, Dilated/genetics
- Cardiomyopathy, Dilated/physiopathology
- Cardiomyopathy, Dilated/therapy
- Heart Septal Defects, Atrial/complications
- Heart Septal Defects, Atrial/diagnosis
- Heart Septal Defects, Atrial/genetics
- Heart Septal Defects, Atrial/physiopathology
- Heart Septal Defects, Atrial/surgery
- Humans
- Hypertrophy, Left Ventricular/etiology
- Hypertrophy, Left Ventricular/physiopathology
- Mutation
- NAV1.5 Voltage-Gated Sodium Channel/genetics
- Pacemaker, Artificial
- Pedigree
- Severity of Illness Index
- Treatment Outcome
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226
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Abstract
Mechanical support by means of ventricular assist devices is at present the most promising alternative of efforts aimed at increasing the supply of donor organs. The support of the left dysfunctional ventricle enables appropriate haemodynamic stabilization and recovery of secondary organ failure, often present in these severely ill patients. The current results of left ventricular assist device (LVAD) therapy for bridge to transplantation are excellent when compared with the outcome without the availability of this therapy. Additionally, a rapid extubation of these patients has demonstrated to be efficient in cardiac surgery for faster recovery and rehabilitation. Consequently, in recent years, surgical objectives have become much more clearly defined, and the concept of less invasive cardiac surgery can be applied to make this operation less complicated, anatomically focused with a greater clinical impact. We describe an LVAD implantation technique, applying the concept of less invasive cardiac surgery, consisting in the association of reduced surgical approaches, off-pump implantation and reduced administration of heparin dose, in order to achieve rapid extubation and rehabilitation of the patient, preserving low morbidity, and still meeting all the goals of the standard procedure.
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Affiliation(s)
- Tomaso Bottio
- Department of Cardiology and Cardiovascular Surgery, University of Padova Medical School, Padova, Italy
| | - Jonida Bejko
- Department of Cardiology and Cardiovascular Surgery, University of Padova Medical School, Padova, Italy
| | - Michele Gallo
- Department of Cardiology and Cardiovascular Surgery, University of Padova Medical School, Padova, Italy
| | - Giacomo Bortolussi
- Department of Cardiology and Cardiovascular Surgery, University of Padova Medical School, Padova, Italy
| | - Gino Gerosa
- Department of Cardiology and Cardiovascular Surgery, University of Padova Medical School, Padova, Italy
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227
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Kaya C, Koksal E, Ustun YB, Semizoglu Y, Yilmaz N. Anesthetic management of hysterosalpingooophorectomy in a case with severe idiopathic dilated cardiomyopathy. Med Arch 2014; 68:144-6. [PMID: 24937943 PMCID: PMC4272502 DOI: 10.5455/medarh.2014.68.144-146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Idiopathic dilated cardiomyopathy is a primary myocardial disease with unknown aetiology. This disease follows a prospective course that is characterized by ventricular dilation and impaired myocardial dilation. Congestive heart failure and malignant arrhythmias are the most widespread complications. The incidence of idiopathic dilated cardiomyopathy in the general population is 5-8/100.000. Because of the increased risks of perioperative complications, anesthetic management of this disease requires the application of a specific technique. This case report demonstrates the application of successful regional anesthetic management (thoracic epidural anesthesia) in a patient who had been diagnosed with severe idiopathic dilated cardiomyopathy.
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228
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Maatz H, Jens M, Liss M, Schafer S, Heinig M, Kirchner M, Adami E, Rintisch C, Dauksaite V, Radke MH, Selbach M, Barton PJR, Cook SA, Rajewsky N, Gotthardt M, Landthaler M, Hubner N. RNA-binding protein RBM20 represses splicing to orchestrate cardiac pre-mRNA processing. J Clin Invest 2014; 124:3419-30. [PMID: 24960161 DOI: 10.1172/jci74523] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 05/13/2014] [Indexed: 12/26/2022] Open
Abstract
Mutations in the gene encoding the RNA-binding protein RBM20 have been implicated in dilated cardiomyopathy (DCM), a major cause of chronic heart failure, presumably through altering cardiac RNA splicing. Here, we combined transcriptome-wide crosslinking immunoprecipitation (CLIP-seq), RNA-seq, and quantitative proteomics in cell culture and rat and human hearts to examine how RBM20 regulates alternative splicing in the heart. Our analyses revealed the presence of a distinct RBM20 RNA-recognition element that is predominantly found within intronic binding sites and linked to repression of exon splicing with RBM20 binding near 3' and 5' splice sites. Proteomic analysis determined that RBM20 interacts with both U1 and U2 small nuclear ribonucleic particles (snRNPs) and suggested that RBM20-dependent splicing repression occurs through spliceosome stalling at complex A. Direct RBM20 targets included several genes previously shown to be involved in DCM as well as genes not typically associated with this disease. In failing human hearts, reduced expression of RBM20 affected alternative splicing of several direct targets, indicating that differences in RBM20 expression may affect cardiac function. Together, these findings identify RBM20-regulated targets and provide insight into the pathogenesis of human heart failure.
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229
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Kolte D, Khera S, Aronow WS, Palaniswamy C, Mujib M, Ahn C, Jain D, Gass A, Ahmed A, Panza JA, Fonarow GC. Temporal trends in incidence and outcomes of peripartum cardiomyopathy in the United States: a nationwide population-based study. J Am Heart Assoc 2014; 3:e001056. [PMID: 24901108 PMCID: PMC4309108 DOI: 10.1161/jaha.114.001056] [Citation(s) in RCA: 200] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 04/29/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The reported incidence of peripartum cardiomyopathy (PPCM) in the United States varies widely. Furthermore, limited information is available on the temporal trends in incidence and outcomes of PPCM. METHODS AND RESULTS We queried the 2004-2011 Nationwide Inpatient Sample databases to identify all women aged 15 to 54 years with the diagnosis of PPCM. Temporal trends in incidence (per 10 000 live births), maternal major adverse events (MAE; defined as in-hospital mortality, cardiac arrest, heart transplant, mechanical circulatory support, acute pulmonary edema, thromboembolism, or implantable cardioverter defibrillator/permanent pacemaker implantation), cardiogenic shock, and mean length of stay were analyzed. From 2004 to 2011, we identified 34 219 women aged 15 to 54 years with PPCM. The overall PPCM rate was 10.3 per 10 000 (or 1 in 968) live births. PPCM incidence increased from 8.5 to 11.8 per 10 000 live births (Ptrend<0.001) over the past 8 years. MAE occurred in 13.5% of patients. There was no temporal change in MAE rate, except a small increase in in-hospital mortality and mechanical circulatory support (Ptrend<0.05). Cardiogenic shock increased from 1.0% in 2004 to 4.0% in 2011 (Ptrend<0.001). Mean length of stay decreased during the study period. CONCLUSION From 2004 to 2011, the incidence of PPCM has increased in the United States. Maternal MAE rates overall have remained unchanged while cardiogenic shock, utilization of mechanical circulatory support, and in-hospital mortality have increased during the study period. Further study of the mechanisms underlying these adverse trends in the incidence and outcomes of PPCM are warranted.
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Affiliation(s)
- Dhaval Kolte
- Department of Medicine, New York Medical College, Valhalla, NY (D.K., S.K., M.M.)
| | - Sahil Khera
- Department of Medicine, New York Medical College, Valhalla, NY (D.K., S.K., M.M.)
| | - Wilbert S. Aronow
- Division of Cardiology, New York Medical College, Valhalla, NY (W.S.A., C.P., D.J., A.G., J.A.P.)
| | - Chandrasekar Palaniswamy
- Division of Cardiology, New York Medical College, Valhalla, NY (W.S.A., C.P., D.J., A.G., J.A.P.)
| | - Marjan Mujib
- Department of Medicine, New York Medical College, Valhalla, NY (D.K., S.K., M.M.)
| | - Chul Ahn
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX (C.A.)
| | - Diwakar Jain
- Division of Cardiology, New York Medical College, Valhalla, NY (W.S.A., C.P., D.J., A.G., J.A.P.)
| | - Alan Gass
- Division of Cardiology, New York Medical College, Valhalla, NY (W.S.A., C.P., D.J., A.G., J.A.P.)
| | - Ali Ahmed
- University of Alabama at Birmingham and VA Medical Center, Birmingham, AL (A.A.)
| | - Julio A. Panza
- Division of Cardiology, New York Medical College, Valhalla, NY (W.S.A., C.P., D.J., A.G., J.A.P.)
| | - Gregg C. Fonarow
- David‐Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles, CA (G.C.F.)
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Narin N, Hekimoglu B, Baykan A, Ozyurt A, Zararsiz G, Sezer S, Onan SH, Argun M, Pamukcu O, Uzum K. The role of N-terminal proBNP in the clinic scoring of heart failure due to dilated cardiomyopathy in children. Clin Lab 2014; 60:563-70. [PMID: 24779290 DOI: 10.7754/clin.lab.2013.130145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND We aimed to show sensitivity and specificity of NT-ProBNP in demonstrating the degree of cardiac failure caused by dilated cardiomyopathy (DCMP). METHODS From January 2006 to July 2012, thirty patients (2 - 168 months) who had DCMP with acute heart failure and 37 healthy children aged (1 - 168 months) were enrolled in this study. Clinical evaluation was done using a modified Ross scoring system. Ross scoring was done before and after treatment. Patients with a score of > 2 points were included in the study. Ross scoring, echocardiographic parameters, serum NT-ProBNP levels and cardiothoracic index (CTI) were measured before and on the 7th day of treatment. Patients were divided into 3 groups according to degree of heart failure. RESULTS While the change in logNT-ProBNP in the patient group following one-week of treatment was significant (p < 0.05), there was no marked significance in the changes in EF, FS, LVEDD, LVMIz, and CTI. There was a statistically significant difference between logNT-ProBNP levels each Ross clinical group not only before treatment but also on assessment on the 7th day of treatment in the patient group (p < 0.001, Tukey's and Tamhane's T2 post-hoc tests). No significant difference was detected between EF, FS, LVEDDs, LVMIz, and CTI and the stages of acute cardiac failure. The NT-ProBNP levels of patients who became clinically asymptomatic after treatment but still had left ventricular systolic dysfunction were statistically significant when compared to the control group. The cut off value to distinguish healthy children from the patients with left ventricular systolic dysfunction caused by cardiomyopathy was found as 174.3 pg/mL. CONCLUSIONS NT-ProBNP levels are more effective than conventional echocardiographic parameters for clinical determination of the stage of cardiac failures in children with left ventricular systolic dysfunction due to DCMP. Therefore, it can be used for determining the treatment and management of such patients. Furthermore, the test is simple and beneficial, because of its availability in most clinical chemistry laboratories and its advantage of allowing frequent measurements and assessments.
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231
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Caldeira D, Vaz-Carneiro A, Costa J. [Analysis of the Cochrane review: Anticoagulation versus placebo for heart failure in sinus rhythm. Cochrane Database Syst Rev. 2014;3:CD003336]. ACTA MEDICA PORT 2014; 27:284-6. [PMID: 25017336 DOI: 10.20344/amp.5550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 06/05/2014] [Indexed: 11/20/2022]
Abstract
Thrombotic and embolic events contribute to the morbidity and mortality associated to Chronic Heart Failure (HF). Differently from patients with atrial fibrillation (AF) and HF, in which the benefit of anticoagulation is well documented, the use of these drugs in those with HF in sinus rhythm (without AF history) is controversial. In this systematic review from the Cochrane Collaboration, the authors evaluated the benefits and risks associated with oral anticoagulation (versus placebo) in this population. Only 2 randomized controlled trials were published (one with open-label design) enrolling a total of 324 patients. The results of the meta-analysis based on the best available evidence do not support the systematic use of oral anticoagulants in patients with HF and sinus rhythm for preventing death (overall or cardiovascular) or non-fatal cardiovascular events. Furthermore the major bleeding risk was significantly increased.
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Affiliation(s)
- Daniel Caldeira
- Laboratório de Farmacologia Clínica e Terapêutica. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal. Unidade de Farmacologia Clínica. Instituto de Medicina Molecular. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal. Serviço de Cardiologia. Hospital Garcia de Orta. Almada. Portugal
| | - António Vaz-Carneiro
- Centro de Estudos de Medicina Baseada na Evidência. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal. Centro Colaborador Português da Rede Cochrane Iberoamericana. Lisboa. Portugal
| | - João Costa
- Laboratório de Farmacologia Clínica e Terapêutica. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal. Unidade de Farmacologia Clínica. Instituto de Medicina Molecular. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal. Centro de Estudos de Medicina Baseada na Evidência. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal. Centro Colaborador Português da Rede Cochrane Iberoamericana. Lisboa. Portugal
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232
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Zhang W, Huang J, Xu H, Zhang S, Liu Z, Liao Z, Ma X, Liu Q. [Value of cardiopulmonary exercise test in cardiac function evaluation of patients with chronic left heart failure caused by dilated cardiomyopathy]. Zhonghua Yi Xue Za Zhi 2014; 94:1076-1079. [PMID: 24851891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To assess the value of cardiopulmonary exercise test in the evaluation of cardiac function in patients with chronic left heart failure caused by dilated cardiomyopathy. METHODS Fifty-three inpatients aged 18 year and over with chronic left heart failure caused by dilated cardiomyopathy at Fuwai Hospital from October 2010 to October 2011 were selected and divided into 2 groups according to the New York Heart Association (NYHA) heart function classification. One group had 20 cases for class II and another 33 cases for class III-IV. All of them received cardiopulmonary exercise tests. Synchronous measurement and record of gas exchange indices were taken during every breath, and so were heart rate, blood pressure, electrocardiogram and blood oxygen saturation. At the same time, other routine tests were also performed. After exercise test, anaerobic threshold and peak oxygen consumption indices were calculated and statistically analyzed. They also received subsequent follow-ups of 1 day, 1 week, 1 month, 6 months and 1 year, including activities, clinical manifestations and cardiac adverse events. RESULTS At baseline, the differences in gender, age, body mass index, concurrent diseases, left ventricular end-diastolic diameter, left ventricular ejection fraction and serum creatinine had no statistical significance (P > 0.05). Compared with cardiac function class II group, the class III-IV group had higher left atrial diameter, level of amino terminal pro-B-type natriuretic peptide (NT-proBNP), incidence of atrial fibrillation ((51.4 ± 7.5) vs (43.6 ± 7.7) mm, (2 607 ± 1 782) vs (1 312 ± 901) µg/L, 42.4% (14/33) vs 5.0% (1/20)) and lower glomerular filtration rate, peak oxygen consumption, levels of anaerobic threshold ((72 ± 20) vs (97 ± 23) ml/min, (13.7 ± 2.6) vs (20.5 ± 3.6) ml·min(-1)·kg(-1), (10.7 ± 1.5) vs (13.3 ± 2.1) ml·min(-1)·kg(-1)) (all P < 0.01). And NT-proBNP and cardiac function classification showed a positive correlation (OR = 1.002, P = 0.003) while peak oxygen consumption, anaerobic threshold and cardiac function classification were negatively correlated (OR = 0.736, 0.608; P = 0.011, 0.001). CONCLUSIONS Cardiopulmonary exercise test objectively reflects the cardiopulmonary reserve of heart failure patients with dilated cardiomyopathy. And the parameters of anaerobic threshold and peak oxygen consumption may reflect the patient's motor ability quantitatively and accurately.
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Affiliation(s)
- Wei Zhang
- Department of Cardiology, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100037, China
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Gho JMIH, van Es R, Stathonikos N, Harakalova M, te Rijdt WP, Suurmeijer AJH, van der Heijden JF, de Jonge N, Chamuleau SAJ, de Weger RA, Asselbergs FW, Vink A. High resolution systematic digital histological quantification of cardiac fibrosis and adipose tissue in phospholamban p.Arg14del mutation associated cardiomyopathy. PLoS One 2014; 9:e94820. [PMID: 24732829 PMCID: PMC3986391 DOI: 10.1371/journal.pone.0094820] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 03/19/2014] [Indexed: 12/31/2022] Open
Abstract
Myocardial fibrosis can lead to heart failure and act as a substrate for cardiac arrhythmias. In dilated cardiomyopathy diffuse interstitial reactive fibrosis can be observed, whereas arrhythmogenic cardiomyopathy is characterized by fibrofatty replacement in predominantly the right ventricle. The p.Arg14del mutation in the phospholamban (PLN) gene has been associated with dilated cardiomyopathy and recently also with arrhythmogenic cardiomyopathy. Aim of the present study is to determine the exact pattern of fibrosis and fatty replacement in PLN p.Arg14del mutation positive patients, with a novel method for high resolution systematic digital histological quantification of fibrosis and fatty tissue in cardiac tissue. Transversal mid-ventricular slices (n = 8) from whole hearts were collected from patients with the PLN p.Arg14del mutation (age 48±16 years; 4 (50%) male). An in-house developed open source MATLAB script was used for digital analysis of Masson's trichrome stained slides (http://sourceforge.net/projects/fibroquant/). Slides were divided into trabecular, inner and outer compact myocardium. Per region the percentage of connective tissue, cardiomyocytes and fatty tissue was quantified. In PLN p.Arg14del mutation associated cardiomyopathy, myocardial fibrosis is predominantly present in the left posterolateral wall and to a lesser extent in the right ventricular wall, whereas fatty changes are more pronounced in the right ventricular wall. No difference in distribution pattern of fibrosis and adipocytes was observed between patients with a clinical predominantly dilated and arrhythmogenic cardiomyopathy phenotype. In the future, this novel method for quantifying fibrosis and fatty tissue can be used to assess cardiac fibrosis and fatty tissue in animal models and a broad range of human cardiomyopathies.
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Affiliation(s)
- Johannes M. I. H. Gho
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - René van Es
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nikolas Stathonikos
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Magdalena Harakalova
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wouter P. te Rijdt
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Albert J. H. Suurmeijer
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jeroen F. van der Heijden
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nicolaas de Jonge
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Steven A. J. Chamuleau
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Roel A. de Weger
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Folkert W. Asselbergs
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
- Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, the Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Aryan Vink
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
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234
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Alexandrescu DM, Costache II. Acute cardiogenic pulmonary edema--etiological spectrum and precipitating factors. Rev Med Chir Soc Med Nat Iasi 2014; 118:301-306. [PMID: 25076691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM The analysis of the predisposing and precipitating factors encountered in the anamnesis of the patients hospitalized with acute pulmonary oedema, in order to establish some correlations with the evolution and prognosis. MATERIAL AND METHODS The study included 50 patients, 32 males and 18 females, admitted to the Cardiology I Clinic between 2009 and 2013, diagnosed with acute pulmonary oedema upon admission. The following aspects were investigated: cardiovascular antecedents, prodromal elements of the current episode of acute pulmonary oedema (APE), risk factors and associated co morbidities, previous treatments followed at home as well as the triggering factors of the acute episode. RESULTS The main pathology on which the acute pulmonary oedema (APE) episode occurred was represented by: arterial high blood pressure (HBP), dilated cardiomyopathy, ischemic heart disease, valvular heart disease, pre-existing atrial rhythm disorders. The analysis of the factors that precipitated the acute pulmonary oedema episode revealed the following possible triggering conditions: inadequate physical effort on the background of treatment discontinuation, high sodium diet, a prolonged ischemic episode due to inadequate physical effort, rhythm disorder with rapid ventricular response (atrial fibrillation, atrial flutter). In some cases, the risk factors were cumulated. CONCLUSIONS Acute pulmonary oedema represents a major emergency that requires immediate admission to hospital and rapid treatment in the emergency department concurrent with the identification of the triggering and precipitating factors.
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Abstract
BACKGROUND Patients with chronic heart failure (heart failure) are at risk of thromboembolic events, including stroke, pulmonary embolism and peripheral arterial embolism, whilst coronary ischaemic events also contribute to the progression of heart failure. Long-term oral anticoagulation is established in certain patient groups, including patients with heart failure and atrial fibrillation, but there is wide variation in the indications and use of oral anticoagulation in the broader heart failure population. OBJECTIVES To determine whether long-term oral anticoagulation reduces total deaths, cardiovascular deaths and major thromboembolic events in patients with heart failure. SEARCH METHODS We updated the searches in June 2030 in the electronic databases CENTRAL (Issue 6, 2013) in The Cochrane Library, MEDLINE (OVID, 1946 to June week 1 2013) and EMBASE (OVID, 1980 to 2013 week 23). Reference lists of papers and abstracts from national and international cardiovascular meetings were studied to identify unpublished studies. Relevant authors were contacted to obtain further data. No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing oral anticoagulants with placebo in adults with heart failure, and with treatment duration at least one month. Non-randomised studies were also included for assessing side effects. Inclusion decisions were made in duplicate and any disagreement between review authors was resolved by discussion or a third party. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and assessed the risks and benefits of antithrombotic therapy using relative measures of effects, such as odds ratio, accompanied by the 95% confidence intervals. MAIN RESULTS Two RCTs were identified. One compared warfarin, aspirin and no antithrombotic therapy and the second compared warfarin with placebo in patients with idiopathic dilated cardiomyopathy. Three small prospective controlled studies of warfarin in heart failure were also identified, but they were over 50 years old with methods not considered reliable by modern standards. In both WASH 2004 and HELAS 2006, there were no significant differences in the incidence of myocardial infarction, non-fatal stroke and death between patients taking oral anticoagulation and those taking placebo. Four retrospective non-randomised cohort analyses and four observational studies of oral anticoagulation in heart failure included differing populations of heart failure patients and reported contradictory results. AUTHORS' CONCLUSIONS Based on the two major randomised trials (HELAS 2006; WASH 2004), there is no convincing evidence that oral anticoagulant therapy modifies mortality or vascular events in patients with heart failure and sinus rhythm. Although oral anticoagulation is indicated in certain groups of patients with heart failure (for example those with atrial fibrillation), the available data does not support the routine use of anticoagulation in heart failure patients who remain in sinus rhythm.
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Affiliation(s)
- Gregory YH Lip
- University of LiverpoolInstitute of Ageing and Chronic DiseaseLiverpoolUK
| | - Eduard Shantsila
- City Hospital, Sandwell and West Birmingham Hospitals NHS TrustUniversity of Birmingham, Institute of Cardiovascular SciencesBirminghamUKB18 7QH
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236
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Ahmed R, Darrat Y, Hamoudeh E, Elhamdani MO, Yaqub A. Acute cardiomyopathy and multiorgan failure in a patient with pheochromocytoma and neurofibromatosis type 1. J PAK MED ASSOC 2014; 64:214-216. [PMID: 24640818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Pheochromocytomas are catecholamine secreting tumours of the adrenal gland, discovered in 0.1% of patients with hypertension. Our case highlights an atypical presentation of pheochromocytoma in a patient with Neurofibromatosis type 1 who developed cardiogenic shock with multi-organ failure. The patient demonstrated reversible dilated cardiomyopathy during her hospital stay, and her blood pressure fluctuated widely. Discovery of right adrenal mass followed by biochemical testing facilitated the diagnosis. Judicious medical management led to an uneventful surgical removal of the tumour followed by marked stabilization of her blood pressure. We discuss the characteristics of pheochromocytoma associated with Neurofibromatosis type 1 via reversible cardiac dysfunction.
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237
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Işıkay S, Ceylaner S, Karacan M. A child with L-2 hydroxyglutaric aciduria presenting with dilated cardiomyopathy: coincidence or a new syndrome? Anadolu Kardiyol Derg 2014; 14:92-93. [PMID: 24382499 DOI: 10.5152/akd.2013.5079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
MESH Headings
- Brain Diseases, Metabolic, Inborn/blood
- Brain Diseases, Metabolic, Inborn/complications
- Brain Diseases, Metabolic, Inborn/diagnosis
- Cardiomyopathy, Dilated/blood
- Cardiomyopathy, Dilated/complications
- Cardiomyopathy, Dilated/diagnosis
- Child
- Diagnosis, Differential
- Glutarates/urine
- Humans
- Syndrome
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Affiliation(s)
- Sedat Işıkay
- Clinics of Pediatric Neurology Gaziantep Children's Hospital; Gaziantep-Turkey.
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238
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Wang Y, Loghmanpour N, Vandenberghe S, Ferreira A, Keller B, Gorcsan J, Antaki J. Simulation of dilated heart failure with continuous flow circulatory support. PLoS One 2014; 9:e85234. [PMID: 24465511 PMCID: PMC3894974 DOI: 10.1371/journal.pone.0085234] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 11/25/2013] [Indexed: 11/19/2022] Open
Abstract
Lumped parameter models have been employed for decades to simulate important hemodynamic couplings between a left ventricular assist device (LVAD) and the native circulation. However, these studies seldom consider the pathological descending limb of the Frank-Starling response of the overloaded ventricle. This study introduces a dilated heart failure model featuring a unimodal end systolic pressure-volume relationship (ESPVR) to address this critical shortcoming. The resulting hemodynamic response to mechanical circulatory support are illustrated through numerical simulations of a rotodynamic, continuous flow ventricular assist device (cfVAD) coupled to systemic and pulmonary circulations with baroreflex control. The model further incorporated septal interaction to capture the influence of left ventricular (LV) unloading on right ventricular function. Four heart failure conditions were simulated (LV and bi-ventricular failure with/without pulmonary hypertension) in addition to normal baseline. Several metrics of LV function, including cardiac output and stroke work, exhibited a unimodal response whereby initial unloading improved function, and further unloading depleted preload reserve thereby reducing ventricular output. The concept of extremal loading was introduced to reflect the loading condition in which the intrinsic LV stroke work is maximized. Simulation of bi-ventricular failure with pulmonary hypertension revealed inadequacy of LV support alone. These simulations motivate the implementation of an extremum tracking feedback controller to potentially optimize ventricular recovery.
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Affiliation(s)
- Yajuan Wang
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America
| | - Natasha Loghmanpour
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America
| | | | - Antonio Ferreira
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America
- Mathematics, Universidade Federal do Maranhão, Maranhão, Brazil
| | - Bradley Keller
- Cardiovascular Innovation Institute, University of Louisville, Louisville, Kentucky, United States of America
| | - John Gorcsan
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - James Antaki
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
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Davtian KV, Simonian GI, Miasnikov RP, Bazaeva EV, Shanoian AS, Kharlap MS, Maksimova OB, Beregovskaia SA, Andreenko EI, Firstova MI, Churilina VS, Boĭtsov SA. [Hybrid approach to treatment of terminal heart failure]. Kardiologiia 2014; 54:82-86. [PMID: 25902664 DOI: 10.18565/cardio.2014.11.82-86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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240
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Lieu MT, Ng BG, Rush JS, Wood T, Basehore MJ, Hegde M, Chang RC, Abdenur JE, Freeze HH, Wang RY. Severe, fatal multisystem manifestations in a patient with dolichol kinase-congenital disorder of glycosylation. Mol Genet Metab 2013; 110:484-9. [PMID: 24144945 PMCID: PMC3909743 DOI: 10.1016/j.ymgme.2013.09.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 09/29/2013] [Indexed: 12/16/2022]
Abstract
Congenital disorders of glycosylation are a group of metabolic disorders with an expansive and highly variable clinical presentation caused by abnormal glycosylation of proteins and lipids. Dolichol kinase (DOLK) catalyzes the final step in biosynthesis of dolichol phosphate (Dol-P), which is the oligosaccharide carrier required for protein N-glycosylation. Human DOLK deficiency, also known as DOLK-CDG or CDG-Im, results in a syndrome that has been reported to manifest with dilated cardiomyopathy of variable severity. A male neonate born to non-consanguineous parents of Palestinian origin presented with dysmorphic features, genital abnormalities, talipes equinovarus, and severe, refractory generalized seizures. Additional multi-systemic manifestations developed including dilated cardiomyopathy, hepatomegaly, severe insulin-resistant hyperglycemia, and renal failure, which were ultimately fatal at age 9months. Electrospray ionization mass spectrometric (ESI-MS) analysis of transferrin identified a type I congenital disorder of glycosylation; next-generation sequencing demonstrated homozygous p.Q483K DOLK mutations that were confirmed in patient fibroblasts to result in severely reduced substrate binding and catalytic activity. This patient expands the phenotype of DOLK-CDG to include anatomic malformations and multi-systemic dysfunction.
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Affiliation(s)
- Michelle T Lieu
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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241
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Riehle C, Wende AR, Sena S, Pires KM, Pereira RO, Zhu Y, Bugger H, Frank D, Bevins J, Chen D, Perry CN, Dong XC, Valdez S, Rech M, Sheng X, Weimer BC, Gottlieb RA, White MF, Abel ED. Insulin receptor substrate signaling suppresses neonatal autophagy in the heart. J Clin Invest 2013; 123:5319-33. [PMID: 24177427 DOI: 10.1172/jci71171] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 08/29/2013] [Indexed: 01/12/2023] Open
Abstract
The induction of autophagy in the mammalian heart during the perinatal period is an essential adaptation required to survive early neonatal starvation; however, the mechanisms that mediate autophagy suppression once feeding is established are not known. Insulin signaling in the heart is transduced via insulin and IGF-1 receptors (IGF-1Rs). We disrupted insulin and IGF-1R signaling by generating mice with combined cardiomyocyte-specific deletion of Irs1 and Irs2. Here we show that loss of IRS signaling prevented the physiological suppression of autophagy that normally parallels the postnatal increase in circulating insulin. This resulted in unrestrained autophagy in cardiomyocytes, which contributed to myocyte loss, heart failure, and premature death. This process was ameliorated either by activation of mTOR with aa supplementation or by genetic suppression of autophagic activation. Loss of IRS1 and IRS2 signaling also increased apoptosis and precipitated mitochondrial dysfunction, which were not reduced when autophagic flux was normalized. Together, these data indicate that in addition to prosurvival signaling, insulin action in early life mediates the physiological postnatal suppression of autophagy, thereby linking nutrient sensing to postnatal cardiac development.
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242
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Merlo M, Sinagra G, Carniel E, Slavov D, Zhu X, Barbati G, Spezzacatene A, Ramani F, Salcedo E, Di Lenarda A, Mestroni L, Taylor MRG. Poor prognosis of rare sarcomeric gene variants in patients with dilated cardiomyopathy. Clin Transl Sci 2013; 6:424-8. [PMID: 24119082 DOI: 10.1111/cts.12116] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In dilated cardiomyopathy (DCM), the clinical and prognostic implications of rare variants in sarcomeric genes remain poorly understood. To address this question, we analyzed the outcome of rare sarcomeric gene variants in patients enrolled in our Familial Cardiomyopathy Registry. METHODS DCM families harboring rare sarcomeric variants in MYH6, MYH7, MYBPC3, TNNT2, and TTN were identified. Genotype-phenotype association analysis was performed, and long-term survival-free from death or heart transplant was compared between carriers and noncarriers. RESULTS We found 24 rare variants (3 in MYH6, 3 in MYH7, 3 in MYBPC3, 2 in TNNT2, and 13 in TTN) affecting 52 subjects in 25 families. The phenotypes of variant carriers were severe (3 sudden deaths, 6 heart failure deaths, 8 heart transplants, 2 ventricular fibrillations). There was no difference in the overall long-term survival between carriers and the 33 noncarriers (p = 0.322). However after 50 years of age, the combined endpoint of death or transplant was decreased in carriers as compared to noncarriers (p = 0.026). CONCLUSIONS Patients with DCM carrying rare variants in sarcomeric genes manifest a poorer prognosis as compared to noncarriers after the age of 50 years. These data further support the role of genetic testing in DCM for risk stratification.
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Affiliation(s)
- Marco Merlo
- Cardiovascular Institute and Adult Medical Genetics, University of Colorado, Aurora, Colorado, USA; Cardiovascular Department "Ospedali Riuniti,"and University of Trieste, Trieste, Italy
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Chang RY, Lee MY, Kan CB, Hsu WP, Hsiao PC. Oxaliplatin-induced acquired long QT syndrome with torsades de pointes and myocardial injury in a patient with dilated cardiomyopathy and rectal cancer. J Chin Med Assoc 2013; 76:466-9. [PMID: 23769882 DOI: 10.1016/j.jcma.2013.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 03/30/2012] [Indexed: 11/16/2022] Open
Abstract
A 67-year-old woman presented with a history of dilated cardiomyopathy with congestive heart failure since 2003, who subsequently developed lower rectal cancer (adenocarcinoma) with liver, bone, and lymph node metastasis. Abdominoperineal resection and hepatectomy were performed. The patient received two rounds of intravenous chemotherapy, including 12 and six courses of FOLFOX4 (5-fluorouracil, leucovorin, and oxaliplatin; 85 mg/m(2) per cycle). She underwent a third round of intravenous FOLFOX4 because of tumor progression. During the 21(st) course of FOLFOX4 regimen, the patient developed ST segment depression in lead II and prolongation of QT interval with polymorphic ventricular tachycardia, torsades de pointes right after the start of oxaliplatin infusion. Immediate defibrillation and cardiopulmonary resuscitation were administered, and the patient regained spontaneous circulation and consciousness. Twelve-lead electrocardiogram showed ST segment elevation in III, aVF, and ST segment depression in V4-6 after resuscitation. To our knowledge, prolongation of QT interval with torsades de pointes and coronary spasm with myocardial injury that were stabilized in one patient following oxaliplatin infusion has not been reported. We present a patient with these rare complications.
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Affiliation(s)
- Rei-Yeuh Chang
- Division of Cardiology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan, ROC.
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244
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Fazio G, Vernuccio F, Lo Re G, Grassedonio E, Grutta G, Midiri M. Magnetic resonance in the assessment of myocardial perfusion: a reliable alternative to myocardial scintigraphy? Minerva Cardioangiol 2013; 61:483-485. [PMID: 23846014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- G Fazio
- Medical Clinic Riabiliter, Palermo, Italy -
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245
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Chan BT, Abu Osman NA, Lim E, Chee KH, Abdul Aziz YF, Abed AA, Lovell NH, Dokos S. Sensitivity analysis of left ventricle with dilated cardiomyopathy in fluid structure simulation. PLoS One 2013; 8:e67097. [PMID: 23825628 PMCID: PMC3692440 DOI: 10.1371/journal.pone.0067097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 05/15/2013] [Indexed: 11/18/2022] Open
Abstract
Dilated cardiomyopathy (DCM) is the most common myocardial disease. It not only leads to systolic dysfunction but also diastolic deficiency. We sought to investigate the effect of idiopathic and ischemic DCM on the intraventricular fluid dynamics and myocardial wall mechanics using a 2D axisymmetrical fluid structure interaction model. In addition, we also studied the individual effect of parameters related to DCM, i.e. peak E-wave velocity, end systolic volume, wall compliance and sphericity index on several important fluid dynamics and myocardial wall mechanics variables during ventricular filling. Intraventricular fluid dynamics and myocardial wall deformation are significantly impaired under DCM conditions, being demonstrated by low vortex intensity, low flow propagation velocity, low intraventricular pressure difference (IVPD) and strain rates, and high-end diastolic pressure and wall stress. Our sensitivity analysis results showed that flow propagation velocity substantially decreases with an increase in wall stiffness, and is relatively independent of preload at low-peak E-wave velocity. Early IVPD is mainly affected by the rate of change of the early filling velocity and end systolic volume which changes the ventriculo:annular ratio. Regional strain rate, on the other hand, is significantly correlated with regional stiffness, and therefore forms a useful indicator for myocardial regional ischemia. The sensitivity analysis results enhance our understanding of the mechanisms leading to clinically observable changes in patients with DCM.
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Affiliation(s)
- Bee Ting Chan
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia.
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246
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Kourgiannidis G, Anastasakis A, Lampropoulos K, Iliopoulos T. A patient with ventricular tachycardia due to a novel mutation of the lamin A/C gene: case presentation and mini review. Hellenic J Cardiol 2013; 54:326-330. [PMID: 23912926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Lamin A/C is a major constituent of the nuclear lamina, the proteinaceous meshwork underlying the inner nuclear membrane. Laminopathies are a group of diseases with heterogeneous clinical presentation. Lamin A/C mutations are a well-established cause of dilated cardiomyopathy. In our case, a novel mutation of lamin A/C presented in the typical form of cardiolaminopathy with ventricular tachycardia and mild myocardial dysfunction in an apparently healthy, middle-aged individual.
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247
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Shi HW, Pu P, Deng W, Zhou H, Bian ZY, Shen DF, Xie J, Salerno M, Tang QZ. Prognostic value of late gadolinium enhancement in dilated cardiomyopathy patients. A meta-analysis. Saudi Med J 2013; 34:719-726. [PMID: 23860892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE To evaluate the prognostic value of late gadolinium enhancement (LGE) in dilated cardiomyopathy (DCM) patients. METHODS We searched PubMed, MEDLINE, the Cochrane library and EMBASE databases from September to December 2012 in the Renmin Hospital of Wuhan University, Wuhan, China for studies of LGE in DCM patients. We extracted the clinical outcomes (all-cause mortality, cardiovascular mortality, sudden cardiac death [SCD], aborted SCD, heart failure hospitalization) after carefully reviewed. A meta-analysis was performed to calculate pooled odds ratios (OR) with 95% confidence intervals (CIs) for prognostic outcomes in LGE positive versus LGE negative patients with DCM. RESULTS Five studies for 545 DCM patients were contained in this meta-analysis. The results showed LGE positive patients was significantly associated with higher cardiovascular mortality (pooled OR: 2.67; 95% CI: 1.12-6.35; p=0.03), aborted SCD (pooled OR: 5.26; 95% CI: 1.57-17.55; p=0.007), and heart failure hospitalization (pooled OR: 3.91; 95% CI: 1.99-7.69; p<0.001). CONCLUSION Late gadolinium enhancement during cardiac MRI is significantly associated with cardiovascular mortality, aborted SCD and heart failure hospitalization in DCM patients. The LGE can be a potential stratification tool to predict the risk of cardiac events among patients with DCM.
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Affiliation(s)
- Hong-Wei Shi
- Department of Cardiology, Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Hubei, China
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248
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Suciu H, Opriş M, Suciu M, Ispas M, Sglimbea A, Deac R. First heart transplantation in a small child in Romania. Chirurgia (Bucur) 2013; 108:553-556. [PMID: 23958101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2013] [Indexed: 06/02/2023]
Abstract
Heart transplantation is a life-saving procedure for irreducible heart failure in children as in adults. Worldwide there is a great amount of experience with this procedure, while Romania is only at the beginning. The authors are presenting the experience concerning the first small child heart transplantation in Romania, underlining the pre-operative and posttransplantation experience. The patient, a 3 year-old girl, diagnosed with class IV NYHA functional classification congestive heart failure secondary to an idiopathic dilated cardiomyopathy, has received an isogroup isoRh donor heart on the 14th of January 2011. The operative technique used was an orthotopic bicaval technique. In-hospital postoperative evolution was favourable, the child receiving triple immunosuppressive therapy and prophylaxis therapy against cytomegalovirus, fungi, and pneumocystis carinii bacteria. Myocardial biopsy performed 1 month after transplantation showed no signs of rejection. The child is in good health at 31 months (2 years, 8 months) after the transplantation. Heart transplantation in children is the result of teamwork, while the procedure can be performed with low mortality and morbidity in centers with large experience in heart transplantation and pediatric cardiovascular surgery.
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Affiliation(s)
- H Suciu
- Department of Cardiovascular Surgery for Children and Adults, University of Medicine and Pharmacy, Mures, Romania.
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249
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Hochhegger B, Soares Souza A, Zanetti G, Marchiori E. An enlarged heart with hyperdense consolidation. Neth J Med 2013; 71:317-321. [PMID: 23956315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- B Hochhegger
- Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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250
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Inoue T, Fujii K, Yugami S, Kitayama H, Saga T. Symmetrical papillary muscle approximation for functional mitral regurgitation with idiopathic dilated cardiomyopathy. J Heart Valve Dis 2013; 22:556-559. [PMID: 24224420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The cases are reported of mitral valve repair with symmetrical papillary muscle approximation from heads to bases close to cardiac apex for functional mitral regurgitation (FMR). The two papillary heads attaching the chordae to both leaflets from the posteromedial papillary muscle were approximated parallel to the solitary head of the anterolateral papillary muscle. This procedure permits an even reduction of lateral shift of the papillary muscle, resulting in an elimination of mitral tethering, and provides a satisfactory and durable mitral valve repair with good outcomes in patients with idiopathic dilated cardiomyopathy and FMR.
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Affiliation(s)
- Takehiro Inoue
- Department of Cardiovascular Surgery, Mimihara General Hospital, Osaka, Japan.
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