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Milutinovic S, Jancic P, Adam A, Radovanovic M, Nordstrom CW, Ward M, Petrovic M, Jevtic D, Delibasic M, Kotseva M, Nikolajevic M, Dumic I. Cardiomyopathy in Celiac Disease: A Systematic Review. J Clin Med 2024; 13:1045. [PMID: 38398359 PMCID: PMC10889265 DOI: 10.3390/jcm13041045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: Cardiomyopathy in celiac disease or celiac cardiomyopathy (CCM) is a serious and potentially life-threatening disease that can occur in both adults and children. However, data supporting the causal relationship between celiac disease (CD) and cardiomyopathy (CMP) are still inconsistent. The aim of this study was to review and synthesize data from the literature on this topic and potentially reveal a more evidence-based causal relationship. (2) Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to search Medline, Embase, and Scopus databases from database inception until September 2023. A total of 1187 original articles were identified. (3) Results: We identified 28 CCM patients (19 adult and 9 pediatric) with a mean age of 27.4 ± 18.01 years. Adult patients with CCM were predominantly male (84.2%) while pediatric patients were predominantly female (75%). The most common comorbidities associated with CCM were anemia (75%) and pulmonary hemosiderosis (20%). In 35% of patients, CCM occurred before the diagnosis of CD, while in 48% of patients, CCM and CD were diagnosed at the same time. Diagnosis of CD preceded diagnosis of CCM in only 18% of patients. Diagnosis of CCM is often delayed with an average, from the onset of symptoms to diagnosis, of 16 months. All patients were treated with a gluten-free diet in addition to guideline-directed medical therapy. At 11-month follow-up, cardiovascular improvement was seen in 60.7% of patients. Pediatric mortality was 33.3%, while adult mortality was 5.3%. (4) Conclusions: Clinicians should be aware of the possible association between CD and CMP, and we recommend CD work-up in all patients with CMP who have concomitant anemia. While we identified only 28 cases in the literature, many cases might go unreported due to a lack of awareness regarding CCM. A high degree of clinical suspicion and a prompt diagnosis of CCM are essential to minimizing the risks of morbidity and mortality, as the combination of a gluten-free diet and guideline-directed medical therapy can improve clinical outcomes.
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Affiliation(s)
- Stefan Milutinovic
- Internal Medicine Residency Program at Lee Health, Florida State University College of Medicine, Tallahassee, FL 32301, USA; (S.M.); (M.D.)
| | - Predrag Jancic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (P.J.); (M.N.)
| | - Adam Adam
- Cardiology Fellowship Program, Cook County, Chicago, IL 60612, USA;
| | - Milan Radovanovic
- Section of Hospital Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA; (M.R.); (M.W.)
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA;
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Charles W. Nordstrom
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA;
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Marshall Ward
- Section of Hospital Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA; (M.R.); (M.W.)
| | - Marija Petrovic
- Cardiology Fellowship Program, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | | | - Maja Delibasic
- Internal Medicine Residency Program at Lee Health, Florida State University College of Medicine, Tallahassee, FL 32301, USA; (S.M.); (M.D.)
| | | | - Milan Nikolajevic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (P.J.); (M.N.)
| | - Igor Dumic
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA;
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
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Myrmel GM, Lunde T, Dizdar V, Larsen TH, Saeed S. Myocarditis in a Young Patient with Celiac Disease; A Case Report and Literature Review. Open Cardiovasc Med J 2021. [DOI: 10.2174/1874192402115010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Myocarditis has numerous aetiologies, and Celiac Disease (CD) has been described as a rare cause. CD has received little attention in current guidelines and may be underdiagnosed. We report a case involving a 28-year-old male with myocarditis causing severe left ventricular dysfunction and dilatation that was probably related to CD. This case highlights the importance of screening for CD in patients presenting with myocarditis and signs of malabsorption when other common causes are excluded. Besides optimal medical treatment and cardiac resynchronization therapy, a gluten-free diet and immunosuppression may also be effective measures in the management of CD-related myocarditis.
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