Fibrosis and Mortality in Patients With Dilated Cardiomyopathy

Barison, Andrea; Masci, Pier Giorgio; Emdin, Michele

doi:10.1001/jama.2013.6453

Cited by 6 publications

(5 citation statements)

References 5 publications

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“…Recently, other studies reported on the independent prognostic role of LGE in DCM [93][94][95][96][97][98], with some studies showing an optimal LGE threshold around 5 % of left ventricular mass for the composite end point (varying between 4.4 and 5.5 %) [94,96]. Nevertheless, these studies have provided conflicting results about the exact relationships between LGE and other clinical, electrocardiographic or functional parameters [99]. In particular, Hombach et al [95] found that LGE was present in 26 % out of 141 patients with DCM and correlated with an increased risk of death or hospitalization for worsening heart failure; however, its prognostic role was overcome by QRS duration, QTc duration, diabetes mellitus, cardiac index and right ventricular diastolic volume, at multivariate analysis; Masci et al [93] found that LGE remained a strong independent predictor after correction for age, CMR-derived left and right ventricular volumes, echocardiographic measurements of left ventricular diastolic function and Doppler-estimated systolic pulmonary artery pressure.…”

Section: Late Gadolinium Enhancementmentioning

confidence: 99%

Myocardial interstitial remodelling in non-ischaemic dilated cardiomyopathy: insights from cardiovascular magnetic resonance

et al. 2015

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Myocardial remodelling involves not only the myocytes, but also non-myocyte cells and the extracellular matrix, which constitutes around 6 % of the normal heart and includes fluid, collagen and glycoproteins. In non-ischaemic dilated cardiomyopathy (DCM), the cardiac interstitium increases as a result of diffuse interstitial (microscopic) fibrosis, post-necrotic replacement (macroscopic) fibrosis or myocardial oedema. The activation of the renin-angiotensin-aldosterone system is a major determinant of fibroblasts activation and collagen deposition, with the transforming growth factor β as the downstream signal mediator. Endomyocardial biopsy still represents the current reference method for interstitial and replacement myocardial fibrosis assessment, but cardiovascular magnetic resonance (CMR) allows in vivo detection of macroscopic fibrosis with post-contrast late enhancement imaging. Moreover, recent pre- and post-contrast T1 mapping techniques provide a quantitative estimation of myocardial interstitial remodelling, with potential diagnostic and prognostic clinical utility. Here, we review the pathophysiological mechanisms of myocardial interstitial remodelling in DCM, its non-invasive characterization with biomarkers and with CMR, as well as the most recent studies about their clinical utility.

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Section: Late Gadolinium Enhancementmentioning

confidence: 99%

Myocardial interstitial remodelling in non-ischaemic dilated cardiomyopathy: insights from cardiovascular magnetic resonance

et al. 2015

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“…LV dysfunction is reliably diagnosed on CMR if the wall thickness to chamber radius ratio is found to be reduced. 13 Black blood images allow assessment of ventricular wall thickness.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Role of Cardiovascular Magnetic Resonance Imaging in Dilated Cardiomyopathy

Singla

Mehra

Garga

2021

Indian Journal of Radiology and Imaging

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Aims The purpose of the study was to compare the accuracy of cardiac magnetic resonance (CMR) with echocardiography for the evaluation of ventricular dysfunction in patients of dilated cardiomyopathy (DCM). Further, we evaluated the potential of CMR for myocardial tissue characterization. Design Prospective observational. Materials and Methods A total of 30 patients with suspected DCM prospectively underwent cardiac magnetic resonance (MR) using a 1.5 Tesla MR scanner, with appropriate phased-array body coils. Dynamic sequences after injection of 0.1 mmol/kg of body weight of gadolinium-based intravenous contrast (Magnevist) were acquired for each patient, after which delayed images were obtained at an interval of 12 to 15 minutes. Myocardial tagging was performed in all patients for assessment of wall motion abnormalities. Each MR examination was interpreted with two radiologists for chamber dimensions and ventricular dysfunction as well as morphologic characteristics with disagreement resolved by consensus. All patients included in the study were taken up for MR evaluation after cardiological evaluation through echocardiography and the results for both the studies were compared. Data were analyzed through standard statistical methods. Conclusion CMR is a comprehensive diagnostic tool, which can estimate the ventricular function more precisely than echocardiography. CMR reliably differentiates between ischemic and nonischemic etiologies of DCM based on patterns of late gadolinium enhancement (LGE) and based on the presence or absence of LGE, which helps to estimate the degree of myocardial fibrosis. Thereby it can be a useful tool in establishing risk stratification, predicting prognosis, and thus instituting appropriate therapy in DCM patients.

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“…Since activation of alpha or adrenergic receptors has been shown to induce stress-induced cardiomyopathy, it has been shown in studies that these cardiac effects can be attenuated by pretreatment with the use of alpha and beta blockers [19][20][21][22][23]. In addition, increasing levels of estrogen have shown partial attenuation of these cardiac changes [24,25].…”

Section: Discussionmentioning

confidence: 99%

Epinephrine soaked tampons induced transient acute dilated cardiomyopathy during FESS procedure

Naddaf

Ehrenberg

Hakim

et al. 2020

BMC Cardiovasc Disord

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Background Epinephrine, in all modes of use, may pose a wide range of cardiotoxic events, ranging from sinus tachycardia to heart failure, life threatening arrhythmias, and even death. Because of daily and extensive use of epinephrine, these unusual and rare events tend to be forgotten by physicians. We present a case of dilated cardiomyopathy that developed following routine use of epinephrine-impregnated tampons during function endoscopic sinus (FESS) surgery. Case presentation A healthy, 24-year-old man with no family history of heart disease has undergone elective surgery under general anesthesia to repair the paranasal sinuses using endoscopic approach. During surgery, soon after being treated with 1: 1000 diluted epinephrine-soaked tampons, an hypertensive crisis was noticed followed by pulseless electrical activity. An extensive examination led to the diagnosis of non-ischemic dilated cardiomyopathy. After several days of heart failure medical therapy, complete resolution of all structural and functional changes was achieved. Conclusion In our case, we present an unusual and rare event of acute dilated cardiomyopathy following the use of epinephrine-soaked tampons during elective FESS surgery. A prompt response was observed after several days of heart failure treatment. Awareness of the epinephrine cardiotoxic potential even in the form of soaked tampons is essential for proper diagnosis and prompt treatment.

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Fibrosis and Mortality in Patients With Dilated Cardiomyopathy

Cited by 6 publications

References 5 publications

Myocardial interstitial remodelling in non-ischaemic dilated cardiomyopathy: insights from cardiovascular magnetic resonance

Myocardial interstitial remodelling in non-ischaemic dilated cardiomyopathy: insights from cardiovascular magnetic resonance

Diagnostic Role of Cardiovascular Magnetic Resonance Imaging in Dilated Cardiomyopathy

Epinephrine soaked tampons induced transient acute dilated cardiomyopathy during FESS procedure

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