Improvement of left ventricular systolic function in inflammatory cardiomyopathy: What plays a role?

Krejčí, Jan; Hude, Petr; Ozábalová, Eva; Mlejnek, Dalibor; Žampachová, Víta; Svobodová, Iva; Štěpánová, Radka; Špinarová, Lenka

doi:10.5507/bp.2016.033

Cited by 5 publications

(7 citation statements)

References 49 publications

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“…It is also necessary to mention the possibility of a higher frequency of LV recovery in patients with recently established non-ischemic dilated cardiomyopathy with potential myocarditis, but this was not determined bioptically or by MRI in this patient group 26,27 . The number of patients with NICMP was significantly higher in our sample than in other population of patients with cardiovascular disease, published studies, where, on the contrary, the ischemic etiology of HF predominates 5,7 .…”

Section: Discussionmentioning

confidence: 87%

Heart failure disease management program, its contribution to established pharmacotherapy and long-term prognosis in real clinical practice - retrospective data analysis

Lazarová

Lazár

Málek

et al. 2019

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background and Aims. The prognosis of patients with heart failure (HF) is still generally unfavorable. HF with reduced ejection fraction (HFrEF) patients reach target medication doses in very low percentages in daily clinical practice. HF disease management programs (DMP), including nurse and telemedicine support that facilitate achieving target medication doses, may improve the unfavorable prognosis. Methods. We retrospectively analyzed the data of 738 patients with HFrEF who were followed in a single HF center during the years 1975-2011, for 6.4 (median) years. DMP, nurse and telemedicine support is established at this center. Results. The group achieved left ventricle (LV) recovery after the HF treatment. The median LV ejection fraction improved from 25.0% at baseline to 50.0% at the time of the latest data collection. The proportion of NYHA II, III and IV classes decreased from 27.6%, 30.2% and 29.7% to 26.6%, 7.2% and 0.1%, respectively while the proportion of NYHA class I increased from 12.5% to 66.1%. Median NT-proBNP decreased from 975.0 to 324.0 pg/mL. The survival of the patient group was favorable; 79.7% survived 18.1 years after diagnosis of HF. A high percentage of the patients received recommended target or higher than target doses of angiotensin-converting enzyme inhibitors (82.0%) and beta-blockers (78.1%). Conclusion. The established pharmacotherapy resulted from an effective DMP and this contributed to the favorable prognosis.

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Section: Discussionmentioning

confidence: 87%

Heart failure disease management program, its contribution to established pharmacotherapy and long-term prognosis in real clinical practice - retrospective data analysis

Lazarová

Lazár

Málek

et al. 2019

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…míra iniciálního poškození myokardu, intenzita a délka zánětlivých změn či perzistence virů v myokardu, resp. pokračující virová replikace [6,8,25].…”

Section: Patofyziologie Myokarditidunclassified

“…Iniciální poškození je tedy pod míněno také produkcí negativně inotropních mediá torů spojených se zánětem, jako jsou např. tumor nekro tizující faktor α, interferony či interleukiny [25,28]. To potvrzují i naše vlastní výsledky, které ukazují, že pokles zánětlivé aktivity v kontrolní biopsii je spojen se zlepše ním systolické funkce LK [29].…”

Section: Klinický Obrazunclassified

“…Výsledek EMB může pomoci nejen ve stanovení správné diagnózy, ale současně je důležitý pro prognostickou stratifikaci, pro modifikaci běžné léčby či pro volbu specifické terapie, resp. zhodnocení jejího efektu, a také pro načasování některých terapeutických rozhodnutí, jako je indikace přístrojové léčby či rozhodnutí o srdeční transplantaci [16,17,25,28,29]. Poněkud problematickou skutečností však je, že neexistuje plná shoda na kritériích hodno cení, byť zmiňovaný Position statement ESC navrhl ino vovaná kritéria pro bioptickou diagnostiku myokardi tid [1].…”

Section: Obr 2 Mri Lge V Oblasti Laterální Stěnyunclassified

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Inflammatory myocardial disease

Krejčí¹,

Poloczková²

2019

Vnitr Lek

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I. interní kardioangiologická klinika LF MU a FN u sv. Anny v Brně SouhrnMezi zánětlivá onemocnění srdečního svalu počítáme myokarditidu a zánětlivou kardiomyopatii, což je myokarditida spojená s dysfunkcí srdečního svalu. Příčiny zánětlivých postižení myokardu mohou být infekční, nejčastěji virové, a také neinfekční. Diagnostika je obtížná, klinické suspicium na tuto diagnózu lze stanovit na základě klinického obrazu a neinvazivních diagnostických metod, z nichž nejdůležitější je srdeční magnetická rezonance. Defi nitivní dia gnóza je založena na histologickém a imunohistochemickém průkazu zánětu přímo ze vzorků srdeč ního svalu. Ty lze získat pomocí endomyokardiální biopsie, která je také zlatým standardem diagnostiky. Vyšetření bioptic kých vzorků umožní, kromě samotného průkazu zánětlivých změn, upřesnit jejich charakter a získanou tkáň lze rovněž vyšetřit na přítomnost infekčních agens v myokardu. Na podkladě nálezu lze potom odhadnout prognózu, načasovat další tera peutické kroky (zejména přístrojovou léčbu) a v některých případech podat specifickou léčbu. Klíčová slova: diagnostika -endomyokardiální biopsie -imunosupresivní léčba -myokarditida -zánětlivá kardiomyopatie Inflammatory myocardial disease SummaryInflammatory diseases of the heart muscle include myocarditis and inflammatory cardiomyopathy, which is myo carditis associated with a heart muscle dysfunction. The causes of myocardial inflammatory disorders may be infec tious, most commonly viral, as well as noninfectious. Diagnosing is difficult, the clinical suspicion of this diagnosis can be established based on clinical picture and noninvasive diagnostic methods, the most important of which is cardiac magnetic resonance imaging. The definitive diagnosis is based on histological and immunohistochemical evidence of inflammation directly from heart muscle samples. These can be obtained by endomyocardial biopsy which is also the gold standard of diagnosis. In addition to the demonstration of inflammatory changes, the exami nation of biopsy specimens allows for specification of their character and the obtained tissue can also be exami ned for presence of infectious agents in the myocardium. Based on the findings it is then possible to estimate the prognosis, set the timing of further therapeutic steps (especially devicebased therapy) and, in some cases, admi nister specific treatments.

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“…Importantly, left ventricular reverse remodelling (LVRR), defined as a par-tial improvement of LV systolic function accompanied by reduction of LV volumes, has been identified as a marker of favourable prognosis in RODCM (ref. [8][9][10] ). LVRR may indicate either the beneficial effect of pharmacotherapy, disappearance of myocardial toxic or inflammatory insult.…”

Section: Introductionmentioning

confidence: 99%

Genetic architecture of recent-onset dilated cardiomyopathy in Moravian region assessed by whole-exome sequencing and its clinical correlates

Chaloupka¹,

Piherová²,

Grochová³

et al. 2019

BIOMED PAP

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Aims. Recent-onset dilated cardiomyopathy (RODCM) is a disease of heterogeneous aetiology and clinical outcome. In this pilot study, we aimed to assess its genetic architecture and correlate genotype with left ventricular reverse remodelling (LVRR). Patients and Methods. In this multi-centre prospective observational study, we enrolled 83 Moravian patients with RODCM and a history of symptoms of less than 6 months, for whole-exome sequencing (WES). All patients underwent 12-month clinical and echocardiographic follow-up. LVRR was defined as an absolute increase in left ventricular ejection fraction > 10% accompanied by a relative decrease of left ventricular end-diastolic diameter > 10% at 12 months. Results. WES identified at least one disease-related variant in 45 patients (54%). LVRR occurred in 28 patients (34%), most often in carriers of isolated titin truncated variants, followed by individuals with a negative, or inconclusive WES and carriers of other disease-related variants (56% vs. 42% vs. 19%, P=0.041). Conclusion.A substantial proportion of RODCM cases have a monogenic or oligogenic genetic background. Carriers of non-titin disease-related variants are less likely to reach LVRR at 12-months than other individuals. Genetic testing could contribute to better prognosis prediction and individualized treatment of RODCM.

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Improvement of left ventricular systolic function in inflammatory cardiomyopathy: What plays a role?

Cited by 5 publications

References 49 publications

Heart failure disease management program, its contribution to established pharmacotherapy and long-term prognosis in real clinical practice - retrospective data analysis

Heart failure disease management program, its contribution to established pharmacotherapy and long-term prognosis in real clinical practice - retrospective data analysis

Inflammatory myocardial disease

Genetic architecture of recent-onset dilated cardiomyopathy in Moravian region assessed by whole-exome sequencing and its clinical correlates

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