Abstract
Abstract Immune activation coincides with disturbances in iron and vitamin D metabolism in patients with cardiomyopathy. In this study, we investigated whether there are differences regarding immune activation, iron and vitamin D metabolism between the different cardiomyopathy aetiologies. Patients and methods: Parameters of iron metabolism (haemoglobin, iron, transferrin, transferrin saturation, ferritin, hepcidin), vitamin D metabolism (Ct-FGF23, parathormone, phosphate, vitamin D) and immune activation (C-reactive protein and neopterin) were determined in 149 patients (98 men, 51 women) with non-ischaemic cardiomyopathy. Results: Patients with amyloid cardiomyopathy presented with higher neopterin, ferritin and hepcidin levels than other cardiomyopathy aetiologies. Furthermore, they showed the highest rate of cardiovascular events. C-reactive protein levels were significantly higher in patients with inflammatory cardiomyopathy. Patients with virus positive cardiomyopathy presented with significantly higher ferritin and Ct-FGF23 levels compared to patients with virus negative inflammatory cardiomyopathy. Conclusion: This study indicates that there are some differences regarding the extent of immune activation and inflammation as well as alterations in iron metabolism disorders between different cardiomyopathy aetiologies. Further studies with larger patient cohorts are needed to investigate these findings more precisely.
Highlights
Cardiomyopathies (CMPs) represent a heterogenic group of heart muscle disease
Patients with restrictive CMP (RCM) had a preserved left ventricle (LV)-EF over 50%, were older and tended to have the highest NT-proBNP levels
Patients with signs of myocarditis in the Endomyocardial biopsies (EMB) had a significantly lower left ventricular ejection fraction (LV-EF) compared to patients with no signs of myocarditis in the EMB (29.6 % [24.7 – 45.5] vs. 42.5 % [34.0 – 55.4], p = 0.003)
Summary
Cardiomyopathies (CMPs) represent a heterogenic group of heart muscle disease. The heart muscle can be affected as a primary pathologic process or secondarily in the course of a systemic disorder. CMPs can be classified due to their morphology into dilated CMP (DCM), hypertrophic CMP (HCM), restrictive CMP (RCM), arrhythmogenic right ventricular CMP (ARVC) and undefined CMP [1,2,3]. HCM is the most common genetic heart disease and the most common cause of sudden cardiac death in young adults [5]. RCM is the most uncommon morphologic form of CMPs in developed countries and characterised by an increased myocardial stiffness reflected by diastolic dysfunction usually of the LV [7]. ARVC is a relatively uncommon genetic heart disease that typically affects men between the second and fourth decade of life and is associated with loss of right ventricular myocardium with following substitution by fibrous and fatty tissue [8]
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