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Li M, Huang H. Anesthetic Management of Patients with Dilated Cardiomyopathy Undergoing Noncardiac Surgery. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1567. [PMID: 37763685 PMCID: PMC10533037 DOI: 10.3390/medicina59091567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023]
Abstract
Dilated cardiomyopathy (DCM), a primary myocardial disease, is characterized by dilation of the left or both ventricles and systolic dysfunction with or without congestive heart failure. DCM per se is a well-recognized risk factor for sudden cardiac death and poor surgical outcomes following noncardiac surgery. Surgical trauma/stress represents unique challenges for DCM patient management. Unfortunately, there is a big knowledge gap in managing DCM patients undergoing non-cardiac surgery. Therefore, the aim of our review is to provide basic facts and current advances in DCM, as well as a practical guideline to perioperative care providers, for the management of surgical patients with DCM, who are quite rare compared with the general surgical population. This review summarizes recent advances in the medical management of DCM as well as perioperative assessment and management strategies for DCM patients undergoing noncardiac surgery. Optimal surgical outcomes depend on multiple-disciplinary care to minimize perioperative cardiovascular disturbances.
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Affiliation(s)
| | - Han Huang
- Department of Anesthesiology and Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, China;
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Chand Negi P, Gupta A, Rana M, Asotra S, Ganju N, Merwah R, Sharma R, Kandoria A. Clinical characteristics, etiological profile, treatment and long term outcomes in patients with non ischemic systolic heart failure; Himachal Pradesh Heart failure registry (HP-HF registry). Indian Heart J 2023:S0019-4832(23)00047-0. [PMID: 37003535 DOI: 10.1016/j.ihj.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 11/05/2022] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND The data on clinical characteristics, treatment practices and out comes in patients with Non- ischemic Systolic Heart Failure (NISHF) is limited. We report clinical characteristics, treatment and outcomes in patients with NISHF. METHODS 1004 patients with NISHF were prospectively enrolled and their demographics, clinical characteristics, and treatment were recorded systematically. Patients were followed annually for a median of 3 years (1 year to 8 years) for allcause death, major adverse cardiovascular events (MACE); composite of all-cause death, hospitalization of heart failure, and or for stroke. RESULTS Patients of NISHF were middle-aged (58.8±16.2 years) population with severely depressed left ventricular ejection fraction (29.3±7.02%) and 31.1% had symptoms of advanced Heart failure. Hypertension (43.6%), obesity and or overweight (28.0%), Diabetes (15.0%), and valvular heart disease (11.8%) were the common risk factors. The guideline directed medical treatment was prescribed in more than 80% of the study cohort. Incidence of all cause death and MACE was 7 (6.8, 8.8) per 100 person years and 11(10, 13) per 100 person years respectively. The cumulative incidence of deaths and MACE was 35% (30%, 40%) and 49% (44%, 53%) at 8 years of follow-up. CONCLUSIONS Patients of NISHF were middle-aged population with severely depressed LV systolic function with significant incident morbidity and mortality. Early detection of risk factors and their risk management and enhancing the use of guideline directed treatment may improve the outcomes.
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Affiliation(s)
| | - Ashu Gupta
- Department of Cardiology, IGMC Shimla, 171001, H.P. India
| | - Meena Rana
- Department of Cardiology, IGMC Shimla, 171001, H.P. India
| | - Sanjeev Asotra
- Department of Cardiology, IGMC Shimla, 171001, H.P. India
| | - Neeraj Ganju
- Department of Cardiology, IGMC Shimla, 171001, H.P. India
| | - Rajeev Merwah
- Department of Cardiology, IGMC Shimla, 171001, H.P. India
| | - Rajesh Sharma
- Department of Cardiology, IGMC Shimla, 171001, H.P. India
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Sex Differences, Genetic and Environmental Influences on Dilated Cardiomyopathy. J Clin Med 2021; 10:jcm10112289. [PMID: 34070351 PMCID: PMC8197492 DOI: 10.3390/jcm10112289] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/11/2021] [Accepted: 05/18/2021] [Indexed: 12/15/2022] Open
Abstract
Dilated cardiomyopathy (DCM) is characterized by dilatation of the left ventricle and impaired systolic function and is the second most common cause of heart failure after coronary heart disease. The etiology of DCM is diverse including genetic pathogenic variants, infection, inflammation, autoimmune diseases, exposure to chemicals/toxins as well as endocrine and neuromuscular causes. DCM is inherited in 20–50% of cases where more than 30 genes have been implicated in the development of DCM with pathogenic variants in TTN (Titin) most frequently associated with disease. Even though male sex is a risk factor for heart failure, few studies have examined sex differences in the pathogenesis of DCM. We searched the literature for studies examining idiopathic or familial/genetic DCM that reported data by sex in order to determine the sex ratio of disease. We found 31 studies that reported data by sex for non-genetic DCM with an average overall sex ratio of 2.5:1 male to female and 7 studies for familial/genetic DCM with an overall average sex ratio of 1.7:1 male to female. No manuscripts that we found had more females than males in their studies. We describe basic and clinical research findings that may explain the increase in DCM in males over females based on sex differences in basic physiology and the immune and fibrotic response to damage caused by mutations, infections, chemotherapy agents and autoimmune responses.
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Relationships between Pulmonary Hypertension Risk, Clinical Profiles, and Outcomes in Dilated Cardiomyopathy. J Clin Med 2020; 9:jcm9061660. [PMID: 32492830 PMCID: PMC7355437 DOI: 10.3390/jcm9061660] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 12/28/2022] Open
Abstract
Pulmonary hypertension (PH) in patients with heart failure (HF) contributes to a poorer prognosis. However, in those with dilated cardiomyopathy (DCM), the true prevalence and role of PH is unclear. Therefore, this study aimed to analyze the profile of DCM patients at various levels of PH risk, determined via echocardiography, and its impact on outcomes. The 502 DCM in- and out-patient records were retrospectively analyzed. Information on patient status was gathered after 45.9 ± 31.3 months. Patients were divided into 3 PH-risk groups based on results from echocardiography measurements: low (L, n = 239, 47.6%), intermediate (I, n = 153, 30.5%), and high (H, n = 110, 21.9%). Symptom duration, atrial fibrillation, ventricular tachyarrhythmia, ejection fraction, right atrial area, and moderate or severe mitral regurgitation were found to be independently associated with PH risk. During the follow-up period, 83 (16.5%) DCM patients died: 29 (12.1%) in L, 31 (20.3%) in I, and 23 (20.9%) in H. L-patients had a significantly lower risk of all-cause death (L to H: HR 0.55 (95%CI 0.32–0.98), p = 0.01), while no differences in prognosis were found between I and H. In conclusion, over one in five DCM patients had a high PH risk, and low PH risk was associated with better prognoses.
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Lai L, Jiang R, Fang W, Yan C, Tang Y, Hua W, Fu M, Li X, Luo R. Prognostic impact of right bundle branch block in hospitalized patients with idiopathic dilated cardiomyopathy: a single-center cohort study. J Int Med Res 2020; 48:300060518801478. [PMID: 30318986 PMCID: PMC7287200 DOI: 10.1177/0300060518801478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 08/28/2018] [Indexed: 11/17/2022] Open
Abstract
Objective Idiopathic dilated cardiomyopathy (IDCM) is a primary myocardial disease resulting in symptoms of heart failure. Right bundle branch block (RBBB) is associated with increased cardiovascular risk and all-cause mortality. Therefore, the present study was performed to identify the prognostic impact of RBBB in patients with IDCM. Methods In total, 165 hospitalized patients with IDCM were evaluated. Receiver operating characteristic curve analysis was used to determine the cutoff point, and Cox regression was used to assess risk factors. Results After a median follow-up of 73.1 months (interquartile range, 36.1–88.7 months), 59 (35.8%) patients had died. All-cause mortality was significantly higher in patients with than without RBBB (log-rank χ2 = 9.400), P<0.05. Significant independent predictors of all-cause mortality in patients with IDCM were RBBB (hazard ratio, 2.898; 95% confidence interval, 1.201–6.995) and the left ventricular end-diastolic dimension (LVEDD) (hazard ratio, 1.034; 95% confidence interval, 1.004–1.066) at admission. Patients with RBBB and an LVEDD of ≥63 mm had the highest mortality (log-rank χ2 = 14.854), P<0.05. Conclusion RBBB was an independent predictor of all-cause mortality, and the combination of RBBB and LVEDD provided more clinically relevant information than RBBB alone for assessing the risk of all-cause mortality in patients with IDCM.
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Affiliation(s)
- Li Lai
- Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, Sichuan, People’s Republic of China
| | - Rong Jiang
- Department of Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Hospital of the University of Electronic Science and Technology of China, Chengdu, People’s Republic of China
| | - Wei Fang
- Medical School of the University of Electronic Science and Technology of China, Chengdu, People’s Republic of China
| | - Chao Yan
- Medical School of the University of Electronic Science and Technology of China, Chengdu, People’s Republic of China
| | - Yibin Tang
- Department of Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Hospital of the University of Electronic Science and Technology of China, Chengdu, People’s Republic of China
| | - Wei Hua
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Michael Fu
- Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden
| | - Xiaoping Li
- Department of Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Hospital of the University of Electronic Science and Technology of China, Chengdu, People’s Republic of China
- Medical School of the University of Electronic Science and Technology of China, Chengdu, People’s Republic of China
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Rong Luo
- Institute of Cardiovascular Disease, Chengdu Medical College, People’s Republic of China
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Electrocardiogram signs of right ventricular hypertrophy may help identify pulmonary hypertension in patients with dilated cardiomyopathy. IJC HEART & VASCULATURE 2018; 22:61-66. [PMID: 30603664 PMCID: PMC6307311 DOI: 10.1016/j.ijcha.2018.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 12/15/2018] [Accepted: 12/17/2018] [Indexed: 11/23/2022]
Abstract
Objective To the authors' knowledge, limited data are available regarding the association between Electrocardiogram (ECG) signs of right ventricular hypertrophy (RVH) and pulmonary hypertension (PH) in patients with dilated cardiomyopathy (DCM). We aimed to assess the accuracy of the recommended ECG criteria of RVH for predicting PH in patients with DCM. Methods According to the definition of PH (mPAP ≥ 25 mm Hg), 35 patients with DCM were divided into 2 groups: DCM with PH (n = 22) and DCM without PH (n = 13). Right heart catheterization was performed in all patients. Seventeen parameters of RVH recommended by the AHA/ACCF/HRS for diagnosis of RVH on ECG were determinded. Results The following parameters were correlated with mPAP: RV1 > 6 mm, SV5 > 10 mm, R:SV6 < 0.4, RV1 + SV5 or V6 > 10.5 mm and PII amplitude. The following parameters were significantly different between DCM patients with and without PH: S in V5 (SV5) > 10 mm, S in V6 (SV6) > 3 mm, R:S ratio in V5 (R:SV5) < 0.75, RV1 + SV5 or V6 > 10.5 mm, S > R inI, S > R inII and R:S V1 > R:S V3, although results were no longer significant after correcting for multiple comparisons. High specificity (92.3-100%), lowsensitivity (31.8-50%), high positive predictive value, and low negative predictive value of established parameters of RVH were noted for predicting PH in patients with DCM. Conclusion Several ECG signs of RVH may be useful for in the diagnosis PH in patients with DCM.
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Key Words
- BUN, blood urea nitrogen
- CO, cardiac output
- DBP, diastolic blood pressure
- DCM, dilated cardiomyopathy
- Dilated cardiomyopathy
- ECG
- ECG, electrocardiogram
- LAD, left atrial diameter
- LHD, left heart disease
- LVEDD, left ventricular end diastolic Diameter
- LVEF, left ventricular ejection fraction
- NPV, negative predictive values
- NT pro-BNP, N-terminal fragment pro-brain natriuretic peptide
- NYHA, New York Heart Association
- PA, pulmonary arterial
- PASP, pulmonary artery systolic pressure
- PAWP, pulmonary capillary wedge pressure
- PH, pulmonary hypertension
- PPV, positive predictive values
- PVR, pulmonary vascular resistance
- Pulmonary hypertension
- RHC, right heart catheterization
- RVEDD, right ventricle end diastolic diameter
- RVH, right ventricular hypertrophy
- Right ventricular hypertrophy
- SBP, systolic blood pressure
- TPG, transpulmonary gradient
- mPAP, mean pulmonary artery pressure
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Liu T, Ma X, Liu W, Ling S, Zhao L, Xu L, Song D, Liu J, Sun Z, Fan Z, Luo T, Kang J, Liu X, Dong J. Late Gadolinium Enhancement Amount As an Independent Risk Factor for the Incidence of Adverse Cardiovascular Events in Patients with Stage C or D Heart Failure. Front Physiol 2016; 7:484. [PMID: 27840608 PMCID: PMC5083842 DOI: 10.3389/fphys.2016.00484] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 10/10/2016] [Indexed: 01/06/2023] Open
Abstract
Background: Myocardial fibrosis (MF) is a risk factor for poor prognosis in dilated cardiomyopathy (DCM). Late gadolinium enhancement (LGE) of the myocardium on cardiac magnetic resonance (CMR) represents MF. We examined whether the LGE amount increases the incidence of adverse cardiovascular events in patients with stage C or D heart failure (HF). Methods: Eighty-four consecutive patients with stage C or D HF, either ischemic or non-ischemic, were enrolled. Comprehensive clinical and CMR evaluations were performed. All patients were followed up for a composite endpoint of cardiovascular death, heart transplantation, and cardiac resynchronization therapy with defibrillator (CRT-D). Results: LGE was present in 79.7% of the end-stage HF patients. LGE distribution patterns were mid-wall, epi-myocardial, endo-myocardial, and the morphological patterns were patchy, transmural, and diffuse. During the average follow-up of 544 days, 13 (15.5%) patients had endpoint events: 7 patients cardiac death, 2 patients heart transplantation, and 4 patients underwent CRT-D implantation. On univariate analysis, LGE quantification on cardiac magnetic resonance, blood urine nitrogen, QRS duration on electrocardiogram, left ventricular end-diastolic diameter (LVEDD), and left ventricular end-diastolic volume (LVEDV) on CMR had the strongest associations with the composite endpoint events. However, on multivariate analysis for both Model I (after adjusting for age, sex, and body mass index) and Model II (after adjusting for age, sex, BMI, renal function, QRS duration, and atrial fibrillation on electrocardiogram, the etiology of HF, LVEF, CMR-LVEDD, and CMR-LVEDV), LGE amount was a significant risk factor for composite endpoint events (Model I 6SD HR 1.037, 95%CI 1.005–1.071, p = 0.022; Model II 6SD HR 1.045, 95%CI 1.001–1.084, p = 0.022). Conclusion: LGE amount from high-scale threshold on CMR increased the incidence of adverse cardiovascular events for patients in either stage C or D HF.
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Affiliation(s)
- Tong Liu
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Xiaohai Ma
- Department of Radiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Wei Liu
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Shukuan Ling
- State Key Lab of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center Beijing, China
| | - Lei Zhao
- Department of Radiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Lei Xu
- Department of Radiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Deli Song
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Jie Liu
- Department of Vascular Surgery, Chinese PLA General Hospital Beijing, China
| | - Zhonghua Sun
- Department of Medical Radiation Sciences, School of Science, Curtin University Perth, WA, Australia
| | - Zhanming Fan
- Department of Radiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Taiyang Luo
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Junping Kang
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Xiaohui Liu
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Capital Medical University, Beijing Anzhen Hospital Beijing, China
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Schantz DI, Dragulescu A, Memauri B, Grotenhuis HB, Seed M, Grosse-Wortmann L. Effect of hydration status on atrial and ventricular volumes and function in healthy adult volunteers. Pediatr Radiol 2016; 46:1520-7. [PMID: 27492341 DOI: 10.1007/s00247-016-3656-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/11/2016] [Accepted: 06/08/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Assessment of cardiac chamber volumes is a fundamental part of cardiac magnetic resonance (CMR) imaging. While the effects of inter- and intraobserver variability have been studied and have a recognized effect on the comparability of serial cardiac MR imaging studies, the effect of differences in hydration status has not been evaluated. OBJECTIVE To evaluate the effects of volume administration on cardiac chamber volumes. MATERIALS AND METHODS Thirteen healthy adults underwent a baseline cardiac MR to evaluate cardiac chamber volumes after an overnight fast. They were then given two saline boluses of 10 ml/kg of body weight and the cardiac MR was repeated immediately after each bolus. RESULTS From the baseline scan to the final scan there was a significant increase in all four cardiac chamber end-diastolic volumes. Right atrial volumes increased 8.0%, from 61.1 to 66.0 ml/m2 (P<0.001), and left atrial volumes increased 10.0%, from 50.0 to 55.0 ml/m2 (P<0.001). Right ventricular volumes increased 6.0%, from 91.1 to 96.5 ml/m2 (P<0.001), and left ventricular volumes increased 3.2%, from 87.0 to 89.8 ml/m2 (P<0.001). CONCLUSION Hydration status has a significant effect on the end-diastolic volumes of all cardiac chambers assessed by cardiac MR. Thus, hydration represents a "variable" that should be taken into account when assessing cardiac chamber volumes, especially when performing serial imaging studies in a patient.
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Affiliation(s)
- Daryl I Schantz
- The Labatt Family Heart Centre in the Department of Paediatrics, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
- Variety Children's Heart Centre, University of Manitoba, FE241-685 William Avenue, Winnipeg, MB, Canada.
| | - Andreea Dragulescu
- The Labatt Family Heart Centre in the Department of Paediatrics, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada
| | - Brett Memauri
- Department of Radiology, St. Boniface General Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - Heynric B Grotenhuis
- The Labatt Family Heart Centre in the Department of Paediatrics, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada
- Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Mike Seed
- The Labatt Family Heart Centre in the Department of Paediatrics, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lars Grosse-Wortmann
- The Labatt Family Heart Centre in the Department of Paediatrics, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
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Gupta A, Sharma P, Bahl A. Left ventricular size as a predictor of outcome in patients of non-ischemic dilated cardiomyopathy with severe left ventricular systolic dysfunction. Int J Cardiol 2016; 221:310-3. [PMID: 27404697 DOI: 10.1016/j.ijcard.2016.07.090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/04/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Limited data is available regarding prognosis of patients with severe left ventricular (LV) systolic dysfunction and varying LV dimensions. Purpose of this study was to compare outcomes of patients with non-ischemic dilated cardiomyopathy (DCM) with respect to LV size. METHODS 145 patients of DCM cohort with LV ejection fraction <35% were divided into 3 groups. Group 1 with normal LV dimensions, group 2 with mild-moderately enlarged left ventricle and group 3 with severely dilated left ventricle. Primary endpoint was composite of all cause mortality and heart failure hospitalizations at end of follow-up. RESULTS Forty-four patients (30.3%) with normal LV diastolic diameter (51.9±5.3mm) were included in group 1, 57(39.3%) with mild-moderately enlarged LV (61.4±3.7mm) in group 2 and 44(30.3%) with severely enlarged LV (71.3±7.4mm) in group 3. Mean follow-up was 42.2±31.6months. Primary end point occurred in 4 patients (9.1%) in group 1, 8 patients (14%) in group 2 and 9 patients (20.5%) in group 3, p=0.23 by log-rank test. Hazard ratio for primary endpoint in group 2 as compared to group 1 was 1.71(95% CI, 0.51 to 5.67; p=0.39) and in group 3 as compared to group 1 was 1.61(95% CI, 0.89 to 2.91; p=0.11). Of patients with more than two years of follow-up, 2 of 29 patients(6.9%) died in group 1, 3 of 35 patients(8.6%) in group 2 and 3 of 34 patients(8.8%) died in group 3, p=0.95. CONCLUSIONS Intermediate term prognosis of patients with severe LVSD and severely dilated left ventricle is good, with outcomes similar to patients with normal or mild-moderately dilated left ventricle.
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Affiliation(s)
- Ankur Gupta
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prafull Sharma
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Bahl
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Right ventricular dysfunction in patients with idiopathic dilated cardiomyopathy: Prognostic value and predictive factors. Arch Cardiovasc Dis 2016; 109:231-41. [DOI: 10.1016/j.acvd.2015.10.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/03/2015] [Accepted: 10/14/2015] [Indexed: 11/19/2022]
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Evaluation of global circumferential strain as prognostic marker after administration of β-blockers for dilated cardiomyopathy. Int J Cardiovasc Imaging 2014; 30:1279-87. [DOI: 10.1007/s10554-014-0463-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 05/30/2014] [Indexed: 01/25/2023]
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12
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Masci PG, Doulaptsis C, Bertella E, Del Torto A, Symons R, Pontone G, Barison A, Droogné W, Andreini D, Lorenzoni V, Gripari P, Mushtaq S, Emdin M, Bogaert J, Lombardi M. Incremental prognostic value of myocardial fibrosis in patients with non-ischemic cardiomyopathy without congestive heart failure. Circ Heart Fail 2014; 7:448-56. [PMID: 24647118 DOI: 10.1161/circheartfailure.113.000996] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND We conducted a prospective longitudinal study to investigate the yet unknown clinical significance of myocardial fibrosis in patients with non-ischemic cardiomyopathy without history of congestive heart failure (CHF). METHODS AND RESULTS At 3 tertiary referral centers, 228 patients with non-ischemic cardiomyopathy without history of CHF were studied with cardiovascular magnetic resonance for late gadolinium enhancement (LGE) detection and quantification and prospectively followed up for a median of 23 months. The end point was a composite of cardiac death, onset of CHF, and aborted sudden cardiac death. LGE was detected in 61 (27%) patients. Thirty-one of 61 (51%) patients with LGE reached combined end point when compared with 18 of 167 (11%) patients without LGE (hazard ratio, 5.10 [2.78-9.36]; P<0.001). Patients with LGE had greater risk of developing CHF than patients without LGE (hazard ratio, 5.23 [2.61-10.50]; P<0.001) and higher rate of aborted sudden cardiac death (hazard ratio, 8.31 [1.66-41.55]; P=0.010). Multivariate analysis showed that LGE was associated with high likelihood of composite end point independent of other prognostic determinants, including age; duration of cardiomyopathy; and left ventricular volumes, mass, and ejection fraction (hazard ratio, 4.02 [2.08-7.76]; P<0.001). Improvement χ(2) analysis disclosed that LGE addition to models, including clinical data alone or in combination with parameters of left ventricular remodeling and function, yielded an improvement in outcome prediction (P<0.001). Addition of LGE to age and left ventricular ejection fraction improved risk stratification for composite end point (net reclassification improvement, 29.6%) and onset of CHF (net reclassification improvement, 25.4%; both P<0.001). CONCLUSIONS In patients with non-ischemic cardiomyopathy without history of CHF, myocardial fibrosis is a strong and independent predictor of outcome, providing incremental prognostic information and improvement in risk stratification beyond clinical data and degree of left ventricular dysfunction.
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Affiliation(s)
- Pier Giorgio Masci
- From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.).
| | - Constantinos Doulaptsis
- From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.)
| | - Erika Bertella
- From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.)
| | - Alberico Del Torto
- From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.)
| | - Rolf Symons
- From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.)
| | - Gianluca Pontone
- From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.)
| | - Andrea Barison
- From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.)
| | - Walter Droogné
- From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.)
| | - Daniele Andreini
- From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.)
| | - Valentina Lorenzoni
- From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.)
| | - Paola Gripari
- From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.)
| | - Saima Mushtaq
- From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.)
| | - Michele Emdin
- From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.)
| | - Jan Bogaert
- From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.)
| | - Massimo Lombardi
- From the Cardiovascular Magnetic Resonance Department (P.G.M., M.L.), and the Cardiology Department (A.B., A.D.T., M.E.), Fondazione CNR/Regione Toscana "G. Monasterio," Pisa, Italy; Departments of Radiology (C.D., R.S., J.B.) and Cardiology (W.D.), Gasthuisberg University Hospital, Leuven, Belgium; Centro Cardiologico Monzino, Milano, Italy (E.B., G.P., D.A., P.G., S.M.); Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy (D.A.); and Management Institute (V.L.) and Medical Sciences (A.D.T.), Scuola Superiore Sant'Anna, Pisa, Italy (A.D.T., V.L.)
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Fairweather D, Cooper LT, Blauwet LA. Sex and gender differences in myocarditis and dilated cardiomyopathy. Curr Probl Cardiol 2013; 38:7-46. [PMID: 23158412 DOI: 10.1016/j.cpcardiol.2012.07.003] [Citation(s) in RCA: 222] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Heart failure due to nonischemic dilated cardiomyopathy (DCM) contributes significantly to the global burden of cardiovascular disease. Myocarditis is, in turn, a major cause of acute DCM in both men and women. However, recent clinical and experimental evidence suggests that the pathogenesis and prognosis of DCM differ between the sexes. This seminar provides a contemporary perspective on the immune mediators of myocarditis, including interdependent elements of the innate and adaptive immune response. The heart's acute response to injury is influenced by sex hormones that appear to determine the subsequent risk of chronic DCM. Preliminary data suggest additional genetic variations may account for some of the differences in epidemiology, left ventricular recovery, and survival between men and women. We highlight the gaps in our knowledge regarding the management of women with acute DCM and discuss emerging therapies, including bromocriptine for the treatment of peripartum cardiomyopathy.
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Gulati A, Ismail TF, Jabbour A, Ismail NA, Morarji K, Ali A, Raza S, Khwaja J, Brown TDH, Liodakis E, Baksi AJ, Shakur R, Guha K, Roughton M, Wage R, Cook SA, Alpendurada F, Assomull RG, Mohiaddin RH, Cowie MR, Pennell DJ, Prasad SK. Clinical utility and prognostic value of left atrial volume assessment by cardiovascular magnetic resonance in non-ischaemic dilated cardiomyopathy. Eur J Heart Fail 2013; 15:660-70. [PMID: 23475781 DOI: 10.1093/eurjhf/hft019] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
AIMS Echocardiographic studies have shown that left atrial volume (LAV) predicts adverse outcome in small heart failure (HF) cohorts of mixed aetiology. However, the prognostic value of LAV in non-ischaemic dilated cardiomyopathy (DCM) is unknown. Cardiovascular magnetic resonance (CMR) allows accurate and reproducible measurement of LAV. We sought to determine the long-term prognostic significance of LAV assessed by CMR in DCM. METHODS AND RESULTS We measured LAV indexed to body surface area (LAVi) in 483 consecutive DCM patients referred for CMR. Patients were prospectively followed up for a primary endpoint of all-cause mortality or cardiac transplantation. During a median follow-up of 5.3 years, 75 patients died and 9 underwent cardiac transplantation. After adjustment for established risk factors, LAVi was an independent predictor of the primary endpoint [hazard ratio (HR) per 10 mL/m(2) 1.08; 95% confidence interval (CI) 1.01-1.15; P = 0.022]. LAVi was also independently associated with the secondary composite endpoints of cardiovascular mortality or cardiac transplantation (HR per 10 mL/m(2) 1.11; 95% CI 1.04-1.19; P = 0.003), and HF death, HF hospitalization, or cardiac transplantation (HR per 10 mL/m(2) 1.11; 95% CI 1.04-1.18; P = 0.001). The optimal LAVi cut-off value for predicting the primary endpoint was 72 mL/m(2). Patients with LAVi >72 mL/m(2) had a three-fold elevated risk of death or transplantation (HR 3.00; 95% CI 1.92-4.70; P < 0.001). LAVi provided incremental prognostic value for the prediction of transplant-free survival (net reclassification improvement 0.17; 95% CI 0.05-0.29; P = 0.002). CONCLUSIONS LAVi is a powerful independent predictor of transplant-free survival and HF outcomes in DCM. Assessment of LAV improves risk stratification in DCM and should be incorporated into routine CMR examination.
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Motoki H, Borowski AG, Shrestha K, Troughton RW, Tang WW, Thomas JD, Klein AL. Incremental Prognostic Value of Assessing Left Ventricular Myocardial Mechanics in Patients With Chronic Systolic Heart Failure. J Am Coll Cardiol 2012; 60:2074-81. [DOI: 10.1016/j.jacc.2012.07.047] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 07/17/2012] [Indexed: 10/27/2022]
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Perez VADJ, Haddad F, Zamanian RT. Diagnosis and management of pulmonary hypertension associated with left ventricular diastolic dysfunction. Pulm Circ 2012; 2:163-9. [PMID: 22837857 PMCID: PMC3401870 DOI: 10.4103/2045-8932.97598] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Pulmonary hypertension (PH) is commonly seen in patients who present with left ventricular diastolic dysfunction (LVDD) and is considered a marker of poor prognosis. While PH in this setting is thought to result from pulmonary venous congestion, there is a subset of patients in which pulmonary pressures fail to improve with appropriate management of diastolic heart failure and go on to develop a clinical picture similar to that of patients with pulmonary arterial hypertension (PAH). Despite the utility of Doppler echocardiography and exercise testing in the initial evaluation of patients with suspected PH-LVDD, the diagnosis can only be confirmed using right heart catheterization. Management of PH-LVDD centers on both optimizing fluid management and afterload reduction to reducing left ventricular diastolic pressures and also increase pulmonary venous return. To date, there is no clear evidence that addition of PH-specific drugs can improve clinical outcomes, and their use should only be considered in the setting of clinical trials. In conclusion, PH-LVDD remains a challenging clinical entity that complicates the management of left ventricular dysfunction and significantly contributes to its morbidity and mortality. Determination of the optimal diagnostic and treatment strategies for this form of PH should be the goal of future studies.
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Affiliation(s)
- Vinicio A de Jesus Perez
- Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, Stanford, California, USA
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Fairweather D, Petri MA, Coronado MJ, Cooper LT. Autoimmune heart disease: role of sex hormones and autoantibodies in disease pathogenesis. Expert Rev Clin Immunol 2012; 8:269-84. [PMID: 22390491 DOI: 10.1586/eci.12.10] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiovascular disease (CVD) and autoimmune diseases (ADs) are the first and third highest causes of death in the USA, respectively. Men have an increased incidence of the majority of CVDs, including atherosclerosis, myocarditis, dilated cardiomyopathy and heart failure. By contrast, nearly 80% of all ADs occur in women. However, in one category of ADs, rheumatic diseases, CVD is the main cause of death. Factors that link rheumatic ADs to CVD are inflammation and the presence of autoantibodies. In this review we will examine recent findings regarding sex differences in the immunopathogenesis of CVD and ADs, explore possible reasons for the increased occurrence of CVD within rheumatic ADs and discuss whether autoantibodies, including rheumatoid factor, could be involved in disease pathogenesis.
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Affiliation(s)
- DeLisa Fairweather
- Johns Hopkins University Bloomberg School of Public Health, Department of Environmental Health Sciences, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
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Xie BQ, Tian YQ, Zhang J, Zhao SH, Yang MF, Guo F, Wang DY, Wei HX, Chu KW, He ZX. Evaluation of left and right ventricular ejection fraction and volumes from gated blood-pool SPECT in patients with dilated cardiomyopathy: comparison with cardiac MRI. J Nucl Med 2012; 53:584-91. [PMID: 22393224 DOI: 10.2967/jnumed.111.096057] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED This prospective study evaluated the accuracy of electrocardiogram-gated blood-pool SPECT (GBPS) for the assessment of left ventricular (LV) and right ventricular (RV) ejection fraction (EF), end-diastolic volume (EDV), and end-systolic volume (ESV) in patients with dilated cardiomyopathy (DCM), using cardiac magnetic resonance (CMR) imaging as the reference standard. METHODS Thirty-two patients (24 men and 8 women; mean age, 51 y) with a diagnosis of idiopathic DCM underwent GBPS and CMR. LV and RV parameters including EDV, ESV, and EF from GBPS were calculated using fully automated gradient software and compared with those obtained by CMR. RESULTS Biventricular volumes were underestimated by GBPS, compared with CMR (P < 0.001). We found no statistical difference between these 2 methods in the assessment of LV EF (P = 0.23), whereas RV EF was overestimated by GBPS (P < 0.001 vs. CMR). Regression analysis yielded significant correlations between GBPS and CMR in the assessments of biventricular parameters (r = 0.83 for LV EDV, 0.88 for LV ESV, 0.89 for LV EF, 0.86 for RV EDV, 0.86 for RV ESV, and 0.62 for RV EF; all P < 0.001). Comparison of the deviations of RV indices between GBPS and CMR with the ratio of RV EDV to LV EDV showed that there was a statistically significant trend for RV volumes to be underestimated and for RV EF to be overestimated as the biventricular volumetric ratio decreased (r = 0.61 for RV EDV, 0.68 for RV ESV, and -0.55 for RV EF; all P < 0.001). CONCLUSION For patients with DCM, GBPS correlated well with CMR for the assessment of biventricular parameters, but RV indices should be cautiously interpreted.
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Affiliation(s)
- Bo-Qia Xie
- Department of Nuclear Medicine, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Pyxaras SA, Pinamonti B, Barbati G, Santangelo S, Valentincic M, Cettolo F, Secoli G, Magnani S, Merlo M, Lo Giudice F, Perkan A, Sinagra G. Echocardiographic evaluation of systolic and mean pulmonary artery pressure in the follow-up of patients with pulmonary hypertension. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:696-701. [PMID: 21821609 DOI: 10.1093/ejechocard/jer127] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS To identify a correction of the modified Bernoulli formula used to estimate systolic and mean pulmonary artery pressure [sPAP and mPAP; respectively: sPAP = 4 × TRv (tricuspid regurgitation velocity)(2)+ RAP (right atrial pressure); and mPAP = 0.61sPAP + 2], applicable in the follow-up of pulmonary hypertension (PH) patients. METHODS AND RESULTS From January 1979 to December 2009, 60 patients with precapillary (class I and IV) and 'out of proportion' PH were consecutively enrolled in the PH Registry of Trieste. All patients underwent both echocardiographic and right heart catheter evaluation. We used a simple-linear-regression method in order to compare sPAP and mPAP Doppler-estimated values with the respective right-heart catheterization invasive variables. The comparison of the estimated with the traditional modified Bernoulli formula echo-Doppler data and the effective invasive values confirmed a significant association between them (for sPAP P< 0.001; for mPAP P= 0.006). Simple-linear-regression-derived formulas were sPAP = 1.07 × (4TRv(2)+ RAP) + 7.4 (1) and mPAP = 1.1 × (0.61sPAP + 2) + 2.5 (2). These regression-corrected formulas were validated in an external population of PH patients. CONCLUSION Our data suggest that formulas (1) and (2) could be more reliable with respect to the traditional modified Bernoulli equation, when estimating echocardiographically sPAP and mPAP in patients with PH confirmed by right-heart catheterization.
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Affiliation(s)
- Stylianos A Pyxaras
- Cardiovascular Department, Pulmonary Hypertension Division, University Hospital of Trieste, Via Valdoni 7, 34149, Trieste, Italy.
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Mahjoub S, Mehri S, Ourda F, Boussaada R, Zouari B, Ben Arab S. [Epidemiological study of the idiopathic dilated cardiomyopathy in Tunisia]. Ann Cardiol Angeiol (Paris) 2011; 60:202-206. [PMID: 21663894 DOI: 10.1016/j.ancard.2011.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2010] [Accepted: 04/18/2011] [Indexed: 05/30/2023]
Abstract
AIMS OF THE STUDY Idiopathic dilated cardiomyopathy (IDC) is a complex disease. The interest of this study were to investigate the epidemiology characteristics of the disease and to evaluate the prognostic echocardiographic markers by region in order to highlight the existence of genetic risk factors and/or environmental and to identify those patients who could benefit from early treatment and better care to avoid further complications of the disease. PATIENTS AND METHODS This is a retrospective study based on the Fischer exact and bilateral Mann-Whitney test. RESULTS We included 526 patients with dilated cardiomyopathies of them we detected 50 cases of IDC including 12 families: The average age was 39,3±15.2 years. The sex ratio was 2.6. Mean left ventricular end-diastolic diameter (DIVGd) was higher in patients from the North East region (44.3±6.2mm/m(2)). Using Receiver Operating Characteristics (ROC) curve, we found a threshold value of 40mm/m(2). The odds ratio associated with this cutoff was 9.2. CONCLUSION Our results suggest that the prevalence and severity of IDC were higher in the North East region of Tunisia. Furthermore, large-scale prospective studies are needed to confirm these findings. In confirmation of a higher prevalence, a genetic study should be undertaken in this region.
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Affiliation(s)
- S Mahjoub
- Unité d'épidémiologie génétique et moléculaire, Tunis, Tunisie.
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Stipac AV, Otasević P, Popović ZB, Cvorović V, Putniković B, Stanković I, Nesković AN. Prognostic significance of contractile reserve assessed by dobutamine-induced changes of Tei index in patients with idiopathic dilated cardiomyopathy. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 11:264-70. [PMID: 19995800 DOI: 10.1093/ejechocard/jep208] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Alja Vlahović Stipac
- Department of Cardiology, Clinical Hospital Center Zemun, Vukova 9, 11080 Belgrade, Serbia.
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Lafitte S. Do we need new echocardiographic prognosticators for the management of heart failure patients? J Am Coll Cardiol 2009; 54:625-7. [PMID: 19660693 DOI: 10.1016/j.jacc.2009.04.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 04/07/2009] [Indexed: 11/25/2022]
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Evaluation of left ventricular volumes and ejection fraction by gated SPECT and cardiac MRI in patients with dilated cardiomyopathy. Eur J Nucl Med Mol Imaging 2009; 36:1611-21. [DOI: 10.1007/s00259-009-1136-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Accepted: 03/23/2009] [Indexed: 11/25/2022]
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Normalization of Ejection Fraction and Resolution of Symptoms in Chronic Severe Heart Failure is Possible With Modern Medical Therapy: Clinical Observations in 11 Patients. Am J Ther 2008; 15:206-13. [DOI: 10.1097/mjt.0b013e3181728a1d] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Flynn JM, Lannigan DA, Clark DE, Garner MH, Cammarata PR. RNA suppression of ERK2 leads to collapse of mitochondrial membrane potential with acute oxidative stress in human lens epithelial cells. Am J Physiol Endocrinol Metab 2008; 294:E589-99. [PMID: 18171912 DOI: 10.1152/ajpendo.00705.2007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
17beta-Estradiol (E(2)) reduces oxidative stress-induced depolarization of mitochondrial membrane potential (MMP) in cultured human lens epithelial cells (HLE-B3). The mechanism by which the nongenomic effects of E(2) contributed to the protection against mitochondrial membrane depolarization was investigated. Mitochondrial membrane integrity is regulated by phosphorylation of BAD, and it is known that phosphorylation of Ser(112) inactivates BAD and prevents its participation in the mitochondrial death pathway. We found that E(2) rapidly increased both the phosphorylation of ERK2 and Ser(112) in BAD. Ser(112) is phosphorylated by p90 ribosomal S6 kinase (RSK), a Ser/Thr kinase, which is a downstream effector of ERK1/2. Inhibition of RSK by the RSK-specific inhibitor SL0101 did not reduce the level of E(2)-induced phosphorylation of Ser(112). Silencing BAD using small interfering RNA did not alter mitochondrial membrane depolarization elicited by peroxide insult. However, under the same conditions, silencing ERK2 dramatically increased membrane depolarization compared with the control small interfering RNA. Therefore, ERK2, functioning through a BAD-independent mechanism regulates MMP in humans lens epithelial cells. We propose that estrogen-induced activation of ERK2 acts to protect cells from acute oxidative stress. Moreover, despite the fact that ERK2 plays a regulatory role in mitochondrial membrane potential, estrogen was found to block mitochondrial membrane depolarization via an ERK-independent mechanism.
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Affiliation(s)
- James M Flynn
- Dept. of Cell Biology and Genetics, Univ. of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX 76107, USA
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26
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Blair JEA, Manuchehry A, Chana A, Rossi J, Schrier RW, Burnett JC, Gheorghiade M. Prognostic markers in heart failure--congestion, neurohormones, and the cardiorenal syndrome. ACTA ACUST UNITED AC 2008; 9:207-13. [PMID: 17891672 DOI: 10.1080/17482940701606913] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
There are several markers of poor prognosis in heart failure (HF). The most established markers of poor prognosis in HF include neurohormonal (NH) imbalance, low ejection fraction (EF), ventricular arrhythmias, intraventricular conduction delays, low functional capacity, low SBP, and renal failure. The relative importance of these factors is unknown, as they have never been studied together. We present a 74-year-old female with nonischemic cardiomyopathy and an EF<20% who over 24 years since diagnosis, never developed clinical or hemodynamic congestion, was never hospitalized for HF, and never required a loop diuretic. She had all of the clinical indicators of poor prognosis in HF except for severe NH imbalance and renal failure, illustrating their importance in HF prognosis. While NH activation in HF is initially an adaptive mechanism, an imbalance of NH effectors causes congestion leading to a vicious cycle of congestion, renal dysfunction, and worsening of HF. The combination of NH activation and renal failure in HF is a vasomotor nephropathy known as the cardiorenal syndrome (CRS) and portends a poor prognosis. Pharmacological disruption of NH pathways early in HF may prevent CRS and, therefore, improve outcomes.
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Stern J, Heist EK, Murray L, Alabiad C, Chung J, Picard MH, Semigran MJ, Ruskin JN, Singh JP. Elevated Estimated Pulmonary Artery Systolic Pressure is Associated with an Adverse Clinical Outcome in Patients Receiving Cardiac Resynchronization Therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:603-7. [PMID: 17461868 DOI: 10.1111/j.1540-8159.2007.00719.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND A substantial percentage of patients with heart failure remain nonresponsive to cardiac resynchronization therapy (CRT). There is a paucity of information on the impact of baseline elevated pulmonary artery pressure on clinical outcome and on left ventricular reverse remodeling (LV-RR) after CRT. We sought to investigate the impact of elevated estimated pulmonary artery systolic pressure (ePASP) on clinical outcome and LV-RR after CRT. METHODS This study retrospectively analyzed data from 68 subjects with standard indications for CRT over a 12-month period. Subjects were stratified into two groups based on the echocardiographic estimation of pulmonary artery pressure i.e., ePASP > or = 50 mmHg (n = 27) and ePASP < 50 mmHg (n = 41). Long-term response was measured as a combined endpoint of heart failure hospitalizations and all cause mortality at 12 months, and compared within the two groups using the Kaplan-Meier method. Follow up echocardiograms to assess for LV-RR were available in 51 subjects (mean duration 7.1 months). LV-RR was defined as any improvement in global systolic function with reduction in left ventricular internal diameter. RESULTS The study population was composed of 24 women and 44 men (age, mean +/- SD; 70 +/- 11 years), with a decreased left ventricular ejection fraction ([25 +/- 9]%) and a wide QRS (171 +/- 54 ms). There were no significant differences in the clinical features between the high and low ePASP group. Subjects with ePASP > or = 50 mmHg had a significantly worse clinical outcome (Hazard ratio (95% CI), 2.0 (1.2-5.5), P = 0.02). Baseline ePASP was not predictive of LV-RR (P = 0.32). CONCLUSION In patients receiving CRT, although elevated estimated pulmonary artery systolic pressure (ePASP > or = 50 mmHg) does not significantly impact LV reverse remodeling, it is associated with an adverse long-term outcome.
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Affiliation(s)
- Joshua Stern
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
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28
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Abstract
Pulmonary hypertension (PH) denotes a poor prognosis in patients with left-sided heart disease. No study has demonstrated long-term benefit from PH drugs such as prostanoids, endothelin antagonists, and phosphodiesterase-5 inhibitors. In some cases, cautious use of PH drugs may be indicated. However, theoretic and practical concerns limit any formal recommendations.
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Affiliation(s)
- Ronald J Oudiz
- David Geffen School of Medicine at UCLA, CA 90502-2006, USA.
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29
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Hedberg P, Jonason T, Lönnberg I, Nilsson G, Pehrsson K, Ringqvist I. Mitral Annulus Motion as a Predictor of Mortality in a Community-based Sample of 75-year-old Men and Women. J Am Soc Echocardiogr 2006; 19:88-94. [PMID: 16423675 DOI: 10.1016/j.echo.2005.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2005] [Indexed: 10/25/2022]
Abstract
Mitral annulus motion (MAM) is a predictor of mortality in selected patient groups, but its prognostic value in less selected populations is not known. In a community-based random sample of 75-year-old men and women (n = 408), left ventricular function was measured as: (1) maximum amplitude of MAM; and (2) wall-motion index. During a median follow-up of 7.2 years, 83 persons died (26 from cardiac causes). Left ventricular function as measured by MAM predicted the risk of all-cause and cardiac mortality independently of other potential risk factors in this community-based sample. Regarding cardiac mortality, the predictive ability of MAM was also independent of left ventricular systolic function measured as wall-motion index. MAM may prove to be a valuable complement to other echocardiographic methods in the assessment of prognosis in less selected populations.
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Affiliation(s)
- Pär Hedberg
- Department of Clinical Physiology, Central Hospital, Västerås, Sweden.
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30
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Christ M, Klima T, Grimm W, Mueller HH, Maisch B. Prognostic significance of serum cholesterol levels in patients with idiopathic dilated cardiomyopathy. Eur Heart J 2005; 27:691-9. [PMID: 15821011 DOI: 10.1093/eurheartj/ehi195] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Previous studies indicate that low cholesterol levels are associated with adverse prognosis in heart failure patients, because elevated lipoprotein levels may negate bacterial endotoxin load induced by gastrointestinal congestion. METHODS AND RESULTS We examined the prognostic significance of lipid levels in a cohort of 422 patients with idiopathic dilated cardiomyopathy (iDCM) [50+/-12 years, 342 males, 80 females, left ventricular ejection fraction (LV-EF): 31.6+/-10.6%]. During 42 months of follow-up, 86 patients (20.3%) died or received a heart transplant. In univariate Cox regression analysis, reduced LV-EF, high New York Heart Association (NYHA) class, and increased LV end-diastolic diameter (LVEDD) were strong risk factors associated with that endpoint, whereas decreased total cholesterol, HDL-cholesterol, and apoprotein I levels were identified as weak risk predictors. After step-wise multivariable analysis, only LVEDD, NYHA class, and LV-EF emerged as parameters independently contributing to the model predicting risk for death or heart transplantation (P<0.05). Cholesterol levels were positively associated with LV-EF and negatively associated with LVEDD (P<0.05). Circulating sCD14 levels, a marker of endotoxin exposure, were related to cholesterol levels (P<0.05) and LV-EF (P<0.05). CONCLUSION Decreased cholesterol levels do not independently predict adverse prognosis in patients with iDCM. Our findings indicate that low cholesterol levels are dependent on the severity of cardiac disease.
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Affiliation(s)
- Michael Christ
- Klinik für Innere Medizin, Kardiologie und Intensivmedizin, Philipps University Marburg, Baldingerstrasse, D-35033 Marburg, Germany.
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Grzybowski J, Bilinska ZT, Janas J, Michalak E, Ruzyllo W. Plasma concentrations of N-terminal atrial natriuretic peptide are raised in asymptomatic relatives of dilated cardiomyopathy patients with left ventricular enlargement. Heart 2002; 88:191-2. [PMID: 12117857 PMCID: PMC1767233 DOI: 10.1136/heart.88.2.191] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- J Grzybowski
- Department of General Cardiology, Institute of Cardiology, Warsaw, Poland
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32
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Drozdz J, Krzemińska-Pakula M, Plewka M, Ciesielczyk M, Kasprzak JD. Prognostic value of low-dose dobutamine echocardiography in patients with idiopathic dilated cardiomyopathy. Chest 2002; 121:1216-22. [PMID: 11948056 DOI: 10.1378/chest.121.4.1216] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Dobutamine echocardiography is widely used for the evaluation of myocardial contractile reserve. The purpose of the study was to determine the prognostic value of low-dose dobutamine echocardiography in patients with idiopathic dilated cardiomyopathy (IDCM). PATIENTS The study group consisted of 77 consecutive patients with recently diagnosed IDCM (mean [+/- SD] age, 49 +/- 9 years; men, 82%) and left ventricular (LV) ejection fractions of < 40%. INTERVENTIONS Two-dimensional and Doppler echocardiographic variables were measured before and after the infusion of dobutamine at the rate of 10 microg/kg/min for 5 min. MEASUREMENTS AND RESULTS During a mean follow-up period of 63 +/- 7 months (range, 49 to 75 months) 30 patients (39%) died and five patients (6%) underwent successful heart transplantations. Using multivariate regression analysis, the only significant factors related to fatal outcome or the need for cardiac transplantation were the following: (1) LV end-systolic volume of > 150 mL after low-dose dobutamine infusion (odds ratio [OR], 2.2; confidence interval [CI], 1.2 to 4.1; p = 0.011); (2) no decrease of LV end-diastolic volume after dobutamine infusion (OR, 1.9; CI, 1.1 to 3.4; p = 0.031); (3) atrial fibrillation (OR, 2.7; CI, 1.4 to 5.3; p = 0.003); and (4) male gender (OR, 2.6; CI, 1.2 to 5.5; p = 0.017). A scoring system was proposed with one point assigned for each of the above-mentioned factors. The mortality rates for total scores of 0, 1, 2, 3, and 4 were 0%, 19%, 48%, 83%, and 100%, respectively. CONCLUSION The response of the LV to low-dose dobutamine infusion adds clinically valuable prognostic information to the evaluation of the patient with IDCM.
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Affiliation(s)
- Jaroslaw Drozdz
- Department of Cardiology, Medical University of Lódź, Lódź, Poland.
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Affiliation(s)
- E J Eichhorn
- Cardiac Catheterization Laboratory and Department of Internal Medicine (Division of Cardiology), Dallas Veterans Administration Hospital, TX 75216, USA
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Nield LE, McCrindle BW, Bohn DJ, West LJ, Coles JG, Freedom RM, Benson LN. Outcomes for children with cardiomyopathy awaiting transplantation. Cardiol Young 2000; 10:358-66. [PMID: 10950333 DOI: 10.1017/s1047951100009665] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine factors associated with outcomes after listing for transplantation in children with cardiomyopathies. BACKGROUND Childhood cardiomyopathies form a heterogeneous group of diseases, and in many, the prognosis is poor, irrespective of the etiology. When profound heart failure develops, cardiac transplantation can be the only viable option for survival. METHODS We included all children with cardiomyopathy listed for transplantation between 12/89 and 4/98 in this historical cohort study. RESULTS We listed 31 patients, 15 male and 16 female, 27 with dilated and 4 with restrictive cardiomyopathy, for transplantation. The median age at listing was 5.7 years, with a range from fetal life to 17.8 years. Transplantation was achieved in 23 (74%), with a median interval from listing of 54 days, and a range from zero to 11.4 years. Of the patients, 14 were transplanted within 30 days of listing. Five patients (16%) died before transplantation. Within the Canadian algorithm, one of these was in the third state, and four in the fourth state. One patient was removed from the list after 12 days, having recovered from myocarditis, and two remain waiting transplantation after intervals of 121 and 476 days, respectively. Patients who died were more likely to be female (5/5 vs. 11/26; p=0.04) and to have been in the third or fourth states at listing (5/5 vs. 15/26; p=0.04). The use of mechanical ventricular assistance, in 10 patients, was not a predictor of an adverse outcome. While not statistically significant, survival to transplantation was associated with treatment using inhibitors of angiotensin converting enzyme, less mitral regurgitation, a higher mean ejection fraction and cardiac index, and lower right ventricular systolic pressure. CONCLUSIONS Children with cardiomyopathy awaiting transplantation have a mortality of 16% related to their clinical state at the time of listing.
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MESH Headings
- Adolescent
- Angiotensin-Converting Enzyme Inhibitors/therapeutic use
- Cardiomyopathy, Dilated/complications
- Cardiomyopathy, Dilated/mortality
- Cardiomyopathy, Dilated/physiopathology
- Cardiomyopathy, Dilated/therapy
- Cardiomyopathy, Restrictive/complications
- Cardiomyopathy, Restrictive/mortality
- Cardiomyopathy, Restrictive/physiopathology
- Cardiomyopathy, Restrictive/therapy
- Child, Preschool
- Cohort Studies
- Female
- Heart Transplantation
- Humans
- Infant
- Infant, Newborn
- Male
- Mitral Valve Insufficiency/etiology
- Ontario/epidemiology
- Prognosis
- Stroke Volume
- Survival Analysis
- Systole
- Ventricular Pressure
- Waiting Lists
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Affiliation(s)
- L E Nield
- Department of Paediatrics, The Hospital for Sick Children, The University of Toronto School of Medicine, Ontario, Canada
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35
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Bilinska ZT, Caforio AL, Kuśmierczyk-Droszcz BK, Michalak E, Grzybowski J, Goldman JH, Haven AJ, Rydlewska-Sadowska W, McKenna WJ, Ruzyøøo W. Increased frequency of organ-specific cardiac antibodies in healthy relatives of patients with dilated cardiomyopathy: evidence for autoimmunity in Polish families. Clin Cardiol 1996; 19:794-8. [PMID: 8896912 DOI: 10.1002/clc.4960191008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND AND HYPOTHESIS Autoantibodies represent markers of autoimmune involvement and are found with increased frequency in patients and their symptom-free relatives at risk compared with normal controls. Cardiac-specific autoantibodies, detected by immunofluorescence, were found in 20% of symptom-free relative of patients with dilated cardiomyopathy (DCM) from England and Italy. The role of autoimmunity may vary in DCM patients from Poland due to ethnic differences in genetic susceptibility to autoimmune disease. METHODS We assessed the frequency of the organ-specific cardiac autoantibodies in 162 symptom-free relatives of DCM patients [85 male, mean (SD) age 27 (18) years] and 80 control subjects from Poland. Familial DCM (> 1 affected member) was present in 4 families, nonfamilial DCM in the remaining 24 pedigrees. We performed antibody screening and noninvasive cardiological assessment in the whole group. RESULTS The frequency of cardiac-specific autoantibodies was higher among patients with documented DCM (probands and relatives) (50%) and their symptom-free relatives (38%) than in unrelated normal subjects (10%; p = 0.0001). In 24 (86%) of the pedigrees studied, autoantibodies were found in the proband and/or in at least one family member and tended to be more common in familial than in nonfamilial DCM (50 vs. 35%, p = NS). Echocardiographic indices of left ventricular size and function were similar in relatives with and without detectable antibodies. CONCLUSIONS The presence of cardiac-specific autoantibodies in symptom-free relatives of DCM patients provides evidence for autoimmunity in the majority (86%) of our pedigrees, including both familial and nonfamilial forms of DCM.
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Affiliation(s)
- Z T Bilinska
- National Institute of Cardiology, Warsaw, Poland
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