Diagnosis Of Dilated Cardiomyopathy Research Articles

Risk Stratification of Genetic, Dilated Cardiomyopathies Associated With Neuromuscular Disorders: Role of Cardiac Imaging.

The etiology of dilated cardiomyopathy (DCM) can be grouped as either genetic or nongenetic. More than 50 pathogenic genes have been described, with sarcomeric and lamin A/C mutations being the most common. Mutation carriers for genetic DCM are often asymptomatic until cardiac disease manifests with heart failure, arrhythmias, or sudden cardiac death. Preventive strategies are promising but can only be applied and tested adequately if genetic DCM can be diagnosed at an early stage. Early diagnosis of mutation carriers that may develop overt DCM requires advanced imaging techniques that can detect subtle structural and functional abnormalities. Advanced echocardiographic techniques such as tissue Doppler imaging and speckle tracking strain analysis permit early detection of functional abnormalities, whereas cardiovascular magnetic resonance techniques provide information on tissue characterization and myocardial energetics that may be altered at an early stage. Furthermore, nuclear imaging techniques provide information on cellular function (metabolism, perfusion). Once the diagnosis of overt DCM has been established, various imaging parameters such as echocardiography-based myocardial mechanics and cardiovascular magnetic resonance-based tissue characterization have shown incremental benefit to left ventricular ejection fraction in risk stratification. Further research is required to understand how imaging techniques may help to choose management strategies that could delay progression when instituted early in the course of the disease. The present article reviews the role of imaging in the risk stratification of genetic DCM in general, with specific emphasis on DCM associated with neuromuscular disorders.

Is There a Cardiotoxicity Associated With Metallic Head Hip Prostheses? A Cohort Study in the French National Health Insurance Databases.

BackgroundThere are four distinguishable types of THA devices in wide use, as defined by the femoral and acetabular bearing surfaces: metal-on-polyethylene (MoP), ceramic-on-polyethylene (CoP), metal-on-metal (MoM), and ceramic-on-ceramic (CoC). Metallic head THAs (MoP and MoM) can potentially induce cardiac toxicity because cobalt species, generated at the head-neck trunnion, and in the case of MoM devices, at the articular surface as well, can be absorbed systemically. However, studies have provided inconsistent results.Questions/purposesThe purpose of this study was to assess the risk of dilated cardiomyopathy (DCM) or heart failure (HF) associated with metallic head THAs using data from the French national health insurance databases.MethodsBetween 2008 and 2011 in France, 399,968 patients ≥ 55 years had a first THA. A total of 127,481 were excluded after we applied the exclusion criteria regarding arthroplasty and 17,137 as a result of a history of DCM/HF, recorded in the French national health insurance reimbursement databases, between January 1, 2006, and the date of inclusion. The final cohort included 255,350 individuals (43% men; mean age 72 ± 9 years). Of them, 93,581 (37%) had been implanted with MoP, 58,095 (23%) with CoP, 11,298 (4%) with MoM, and 92,376 (36%) with CoC THAs. Patients were followed until December 2015. Patients with incident DCM/HF were identified by a new entitlement to the long-term disease scheme or a first hospitalization with a diagnosis of DCM or HF. MoP and CoP THAs are generally implanted in old patients, whereas MoM and CoC are mostly indicated in young, active male patients. Thus, to consider the specific indications of the bearing couples, analyses were separately performed in two distinct subcohorts, one comprising patients with MoP or CoP and one comprising patients with MoM or CoC THA. In each subcohort, the DCM/HF risk was compared between patients with metallic head versus nonmetallic head THAs (MoP versus CoP, MoM versus CoC). Hazard ratios (adjusted HRs) of incident DCM/HF were estimated using Cox models adjusted for baseline sex, age, THA characteristics (fixation technique with cement, use of a modular femoral neck), and comorbidities at baseline. Cox models were stratified by sex and age.ResultsThe crude incidence of DCM/HF per 100 person-years was 2.4 in patients with MoP, 1.8 with CoP, 1.2 with MoM, and 1.1 with CoC THAs. Overall, metallic head THAs were associated with a slight increase in DCM/HF risk (MoP versus CoP: adjusted HR, 1.08; 95% confidence interval [CI], 1.05-1.12; p < 0.001; MoM versus CoC: adjusted HR, 1.11; 95% CI, 1.03-1.19; p = 0.007). In the MoM-CoC subcohort, the risk tended to be more pronounced with MoM versus CoC THAs in women (MoM versus CoC: adjusted HR, 1.20; 95% CI, 1.07-1.35; p = 0.002) and patients aged ≥ 75 years (MoM versus CoC: adjusted HR, 1.16; 95% CI, 1.04-1.29; p = 0.009).ConclusionsMetallic head THAs were associated with a slightly increased DCM/HF risk, especially with MoM in women and older patients. Some caveats should be mentioned: severity of DCM or HF was not available and residual confounding cannot be ruled out despite considering many covariates. Our findings suggest that cardiac function should be regularly monitored in patients with metallic head THAs. Further investigations should be planned on large international cohorts.Level of EvidenceLevel III, therapeutic study.

Identifying Non-invasive Tools to Distinguish Acute Myocarditis from Dilated Cardiomyopathy in Children.

There is often a diagnostic dilemma in pediatric patients presenting with depressed ventricular function, as myocarditis and dilated cardiomyopathy (DCM) of other etiologies can appear very similar. Accurate identification is critical to guide treatment and to provide families with the most accurate expectation of long-term outcomes. The objective of this study was to identify patterns of clinical presentation and to assess non-invasive measures to differentiate patients with acute myocarditis from other forms of DCM. We identified all children (< 18years) from our institution with a diagnosis of idiopathic DCM or myocarditis based on endomyocardial biopsy or explant pathology (1996-2015). Characteristics at the time of presentation were compared between patients with a definite diagnosis of myocarditis and those with idiopathic DCM. Data collected included clinical and laboratory data, radiography, echocardiography, and cardiac catheterization data. A total of 58 patients were included in the study; 46 (79%) with idiopathic DCM and 12 (21%) with acute myocarditis. Findings favoring a diagnosis of myocarditis included a history of fever (58 vs. 15%, p = 0.002), arrhythmia (17 vs. 0%, p = 0.003), higher degree of cardiac enzyme elevation, absence of left ventricular dilation (42 vs. 7%, p = 0.002), segmental wall motion abnormalities (58 vs. 13%, p = 0.001), lower left ventricular dimension z-score (3.7 vs. 5.2, p = 0.031), and less severe depression of left ventricular systolic function. There are notable differences between patients with myocarditis and other forms of DCM that can be detected non-invasively at the time of presentation without the need for endomyocardial biopsy. These data suggest that it may be possible to develop a predictive model to differentiate myocarditis from other forms of DCM using non-invasive measures.

An unusual angiographic finding in a patient with an established diagnosis of dilated cardiomyopathy

An unusual angiographic finding in a patient with an established diagnosis of dilated cardiomyopathy

Dilated Cardiomiopathy - Anatomic-Clinical Study

Abstract Introduction. Dilated cardiomyopathy (DCM) is characterized by global cardiac dilation associated with left ventricular (LV) systolic dysfunction without valvar substrate or ischemic heart disease. Diagnosis of idiopathic DCM can only be sustained after excluding other nongenetic causes. Methods. This study was performed on a cohort of 256 patients who died in Emergency County Hospital of Oradea and had diagnosis of DCM; the study was performed on a period of 2 years, from January 2014 until the end of December 2015. These patients were differentiated according to social criteria, background, department of admission, number of autopsies and co-morbidities. Results and Discussion. Diagnosis of DCM was more common in male patients up to the age of 70; after this age the tendency is towards equalization. In patients aged 61-80 years, DCM played a major role in tanatogenesis. Existing clinical trials have shown that patients with idiopathic DCM have a lower mortality than patients with cardiac ischemic disease. Conclusions. Despite the possibility of diagnosis with increased sensitivity and the large number of therapeutic options, multicentre studies and registries are needed to improve the life expectancy of these patients.

Prognostic value of myocardial strain and late gadolinium enhancement on cardiovascular magnetic resonance imaging in patients with idiopathic dilated cardiomyopathy with moderate to severely reduced ejection fraction

BackgroundIt has been reported that left ventricular (LV) myocardial strain and late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) imaging have prognostic value in patients with heart failure (HF). However, previous studies included patients with various systolic functions. This study aimed to investigate the prognostic value of LV myocardial strain and LGE on CMR imaging in patients with idiopathic dilated cardiomyopathy (DCM) with reduced ejection fraction (EF < 40%).MethodsFrom a prospectively followed cohort who underwent CMR between November 2008 and December 2015, subjects with LV EF < 40% and a diagnosis of idiopathic DCM were eligible for this study. The CMR images were analyzed for LV and right ventricular (RV) function, presence and extent of LGE, and LV myocardial strain. The primary outcome was a composite of all-cause death and heart transplantation. The secondary outcome was hospitalization for HF.ResultsA total of 172 patients were included, in whom mean LV EF was 23.7 ± 7.9% (EF 30–40% n = 47; EF < 30% n = 125). During a median follow-up of 47 months, the primary outcome occurred in 43 patients (16 heart transplantations, 29 all-cause deaths), and there were 41 hospitalizations for HF. Univariate Cox proportional hazard regression analysis showed that mean arterial pressure, serum sodium concentration, log of plasma NT-proBNP level, and presence of LGE (HR 2.277, 95% CI: 1.221–4.246) were significantly associated with the primary outcome. However, LV strain had no significant association (HR 1.048, 95% CI: 0.945–1.163). Multivariable analysis showed that presence of LGE (HR 4.73, 95% CI: 1.11–20.12) and serum sodium (HR 0.823, 95% CI: 0.762–0.887) were independently associated with the primary outcome.ConclusionsLGE in CMR imaging was a good predictor of adverse outcomes for patients with idiopathic DCM and reduced EF. Identification of LGE could thus improve risk stratification in high-risk patients. LV strain had no significant prognostic value in patients with moderate to severe systolic dysfunction.

Idiopathic dilated cardiomyopathy in children: Prognostic indicators

Dilated cardiomyopathy (DCM) is a disorder featuring left ventricular dysfunction, heart failure, and a poor prognosis. The etiology is still unclear, despite diagnostic and therapeutic developments. This study was an evaluation of factors affecting the life span of a group of idiopathic DCM patients. A total of 79 patients from between October 2005 and October 2017 with a diagnosis of idiopathic DCM were evaluated retrospectively. Demographic characteristics, clinical information, left ventricular function, treatment, and follow-up of the patients were reviewed based on hospital records. Age, gender, parental consanguinity, cardiomegaly on telecardiography, reduced ejection fraction (EF) and shortening fraction (SF), degree of mitral regurgitation, and intracardiac thrombosis were determined to affect prognosis. The patients were aged 20+-60 months, and the male/female ratio was 1.02/1. The patients most frequently presented with heart failure signs and symptoms (n=59, 74.7%). The most common physical examination findings were a murmur (n=53, 67.1%) and tachycardia (n=48, 60.8%). Cardiomegaly was observed on telecardiography in 73.4% of the patients. The EF and SF values were 35.7+-12.6% and 17.3+-6.5%, respectively. In all, 42 (53.2%) patients had mitral regurgitation of grade 2 or higher. The duration of follow-up was between 1 and 156 months (20+-34.9 months). Intracardiac thrombosis was detected in 4 (5.1%) patients. The mortality rate was 36.7%. When the prognostic factors were compared according to survival time, it was determined that survival was reduced in cases of parental consanguinity, low EF, and cardiomegaly. The most important negative markers affecting the length of survival of DCM patients were parental consanguinity, cardiomegaly detected on telecardiography, and a reduced EF level.

Dilated Cardiomyopathy: Genetic Determinants and Mechanisms.

Nonischemic dilated cardiomyopathy (DCM) often has a genetic pathogenesis. Because of the large number of genes and alleles attributed to DCM, comprehensive genetic testing encompasses ever-increasing gene panels. Genetic diagnosis can help predict prognosis, especially with regard to arrhythmia risk for certain subtypes. Moreover, cascade genetic testing in family members can identify those who are at risk or with early stage disease, offering the opportunity for early intervention. This review will address diagnosis and management of DCM, including the role of genetic evaluation. We will also overview distinct genetic pathways linked to DCM and their pathogenetic mechanisms. Historically, cardiac morphology has been used to classify cardiomyopathy subtypes. Determining genetic variants is emerging as an additional adjunct to help further refine subtypes of DCM, especially where arrhythmia risk is increased, and ultimately contribute to clinical management.

PRELIMINARY CHARACTERIZATION OF DILATED CARDIOMYOPATHY IN A CAPTIVE POPULATION OF BANDED MONGOOSES (MUNGOS MUNGO).

Between 2006 and 2015, a high incidence of dilated cardiomyopathy (DCM) was diagnosed in a captive population of banded mongooses (Mungos mungo) at Chester Zoo, United Kingdom. The aim of this study was to characterize DCM in these mongooses in order to raise awareness of this condition and help inform management and clinical decisions. Prospective clinical assessments, including echocardiography, radiography, and cardiac biomarkers, were carried out in four mongooses remaining in the collection. Radiographs from 15 mature mongooses were reviewed and cardiac size and metrics assessed. Ten postmortem reports and the histologic sections from nine of these cases were reviewed for cardiac lesions. Echocardiographic findings were consistent with a diagnosis of preclinical DCM in one out of the four cases assessed, and it was considered equivocal in a second case. Taurine levels were within normal limits for domestic carnivores. Radiographs in seven mongooses showed right-sided or generalized cardiomegaly. The width of the heart in intercostal spaces and vertebral-tracheal angle on the lateral view were the most-discriminatory radiographic variables for diagnosis of cardiac disease. At necropsy, there was gross pathological evidence consistent with DCM in seven out of 10 mongooses examined. Histopathologically, mild multifocal fibrosis and rare intermyofiber edema were observed. This study provides preliminary evidence that DCM occurs in captive banded mongoose, but etiology and wider prevalence need to be determined.

Iron Laboratory Studies in Pediatric Patients With Heart Failure from Dilated Cardiomyopathy

Iron deficiency (FeD), with or without anemia, in adults with heart failure (HF) is associated with poor outcomes, which can be improved with replacement therapy. A similar therapeutic opportunity may exist for children; however, iron laboratory measurements and FeD have not been described in pediatric patients with HF. A single-center, retrospective study was conducted on 28 patients <21 years old with a diagnosis of dilated cardiomyopathy and HF who had iron laboratories (serum iron, iron saturation, and ferritin) performed. The mean (standard deviation) age at time of laboratory collection was 10.3 (5.5) years. Twenty-seven patients (96.4%) met the criteria for FeD. Serum iron and iron saturation were significantly associated with inpatient hospitalization, being on inotropic medications, or having stage D HF. Low-serum iron was associated with a higher left ventricular end-diastolic dimension and left ventricular end-systolic dimension z-score by echocardiography ((β -2.58, 95% confidence interval [CI] -4.76, -0.40, p = 0.02) and (β -2.43, 95% CI -4.70, -0.17, p = 0.04)), respectively. Low ferritin was associated with higher mortality (relative risk 0.29, 95% CI 0.12, 0.70, p = 0.006). In conclusion, FeD was common in this pediatric cohort with more advanced HF. Iron profile abnormalities were associated with worse HF severity and outcomes including mortality.

Occurrence of cardiorespiratory diseases and impact on lifespan in Swedish Irish Wolfhounds: a retrospective questionnaire-based study

BackgroundAccording to Swedish animal insurance data, Irish Wolfhounds (IW) are 29 times more likely to die from cardiac causes than the baseline breed. Dilated cardiomyopathy (DCM) has a high prevalence in the breed and the disease has been shown to be hereditary in IW. Few studies address respiratory diseases in IW, but reports suggest that the incidence of pneumonia is high. Respiratory diseases are reported as a common cause of death in the breed along with cardiac, neoplastic, musculoskeletal and gastrointestinal diseases. The aim of this study was to investigate mortality, morbidity and lifespan in Swedish IW through a questionnaire-based study. Focus was on DCM and pneumonia and potential association between these diseases. Questionnaires were sent to owners of purebred IW registered in the Swedish Kennel Club, born during 2006–2008. Owners were asked for information concerning occurrence of disease, results of clinical examinations, treatments, cause and date of death.ResultsOverall response rate was 38% (105 completed questionnaires). Median lifespan was 2720 days (7.5 years). Males had shorter lifespan than females (median 2523 and 2836 days, respectively), P = 0.02. The most common causes of death were neoplastic disease (24%), cardiac disease (18%) and respiratory disease (16%). The percentage of dogs with pneumonia on at least one occasion during their lifetime was 37%, with a majority experiencing recurrent episodes (53%). The median lifespan was shorter for dogs affected by pneumonia on at least one occasion (2629 days), compared to dogs without history of pneumonia (2804 days) (P = 0.04), whereas the lifespan did not differ between dogs with or without a diagnosis of DCM. No sex predisposition was found regarding DCM or pneumonia.ConclusionsThis study showed that DCM and pneumonia are common conditions in IW in Sweden, and that dogs affected by pneumonia have a shorter lifespan than those without history of pneumonia. Considering the results from this study and previous studies regarding these diagnoses in IW; cardiac and respiratory disease should be given further attention in the course of improving the general health of the breed.

Histopathological and Immunological Characteristics of Tachycardia-Induced Cardiomyopathy

BackgroundTachycardiomyopathy or tachycardia-induced cardiomyopathy (TCM) has been known for decades as a reversible form of nonischemic cardiomyopathy. However, its mechanism and properties remain poorly understood. ObjectivesThe current study investigated endomyocardial biopsy samples from patients with TCM and compared them with samples from patients with dilated cardiomyopathy (DCM) and inflammatory cardiomyopathy (ICM). MethodsThe study included 189 patients with new-onset heart failure and severely reduced ejection fraction not caused by valvular or ischemic heart disease. Nineteen patients retrospectively fulfilled common criteria of TCM, 79 patients had a diagnosis of DCM, and 91 had a diagnosis of ICM. ResultsPatients with TCM, on the basis of clinical criteria, had stronger myocardial expression of major histocompatibility complex class II molecule and enhanced infiltration of CD68+ macrophages compared with patients with DCM. Furthermore, when compared with patients with ICM, the presence of T cells and macrophages was significantly reduced in TCM. Myocardial fibrosis was detected to a significantly lower degree in patients with TCM compared with patients with DCM and ICM. Electron microscopic examination revealed severe structural changes in patients with TCM. A disturbed distribution pattern of mitochondria was predominantly present in TCM. Quantitative assessment of myocyte morphology revealed significantly enhanced myocyte size compared with patients with ICM. Ribonucleic acid expression analysis identified changes in metabolic pathways among the patient groups. ConclusionsTCM is characterized by changes in cardiomyocyte and mitochondrial morphology accompanied by a macrophage-dominated cardiac inflammation. Thus, further prospective studies are warranted to characterize patients with TCM by endomyocardial biopsy more clearly.

Results of Late Gadolinium Enhancement in Children Affected by Dilated Cardiomyopathy.

Little is known about the clinical value of late gadolinium enhancement (LGE), in children affected by dilated cardiomyopathy (DCM). We retrospectively evaluated 15 patients (8 ± 6 years, 6 males) with diagnosis of DCM who underwent cardiac magnetic resonance since 2014. All scans were performed with a 1.5 T system (Aera, Siemens). Study protocol included cine steady-state free precession sequences, followed by administration of 0.2 mmol/kg of gadolinium-based contrast agent. Inversion recovery Turbo Flash sequences, in the same position of cine images, were acquired 10-15 min after the injection of contrast agent, in order to assess the presence of LGE. The latter was considered positive with a signal intensity >6 SD from normal myocardial tissue. Indexed end-diastolic volume (EDVi) and end-systolic volume (ESVi), and left ventricle (LV) ejection fraction (EF) were calculated by using dedicated software on off-line workstation. Global longitudinal strain and diastolic function were evaluated by echocardiography. Clinical follow-up, including death, transplant, and listing for heart transplant [major adverse cardiac events (MACE)], were evaluated. Patients were divided into two different subgroups: negative (Group A) and positive (Group B) for presence of LGE. Statistical analysis was performed by using Mann-Whitney U test (p < 0.05 considered as statistically significant). Seven patients (47%) showed LGE. A global diffuse subendocardial pattern was evident in all patients presenting LGE (7/7, 100%). The following main LV indexes were observed in the two subgroups. Group A: EDVi = 96 ± 33 ml, ESVi = 56 ± 29 ml, LV EF = 45 ± 10%, global longitudinal strain = -16 ± 5%, E/e' ratio = 10 ± 3, MACE = 1. Group B: EDVi = 130 ± 60 ml, ESVi = 89 ± 43 ml, LV EF = 31 ± 6%, global longitudinal strain = -13 ± 4%, E/e' ratio = 9 ± 3, MACE = 3. There was no statistically significant difference between the two groups, in terms of EDVi (p: 0.2), ESVi (p: 0.2), and E/e' ratio (0.9), whereas a significant difference of LV EF, presence of significative mitral regurgitation, and global longitudinal strain were observed (respectively, p: 0.03, p: 0.009, and p: 0.03). In our population of children with DCM, LGE shows a global diffuse subendocardial pattern. Presence of LGE seems to play a role in these patients determining a worst global systolic function.

RETRACTED ARTICLE: Automated screening of congestive heart failure using variational mode decomposition and texture features extracted from ultrasound images

Heart is an important and hardest working muscular organ of the human body. Inability of the heart to restore normal perfusion to the entire body refers to cardiac failure, which then with symptoms results in manifestation of congestive heart failure (CHF). Impairment in systolic function associated with chronic dilation of left ventricle is referred as dilated cardiomyopathy (DCM). The clinical examination, surface electrocardiogram (ECG), chest X-ray, blood markers and echocardiography play major role in the diagnosis of CHF. Though the ECG manifests chamber enlargement changes, it does not possess sensitive marker for the diagnosis of DCM, whereas echocardiographic assessment can effectively reveal the presence of asymptomatic DCM. This work proposes an automated screening method for classifying normal and CHF echocardiographic images affected due to DCM using variational mode decomposition technique. The texture features are extracted from variational mode decomposed image. These features are selected using particle swarm optimization and classified using support vector machine classifier with different kernel functions. We have validated our experiment using 300 four-chamber echocardiography images (150: normal, 150: CHF) obtained from 50 normal and 50 CHF patients. Our proposed approach yielded maximum average accuracy, sensitivity and specificity of 99.33%, 98.66% and 100%, respectively, using ten features. Thus, the developed diagnosis system can effectively detect CHF in its early stage using ultrasound images and aid the clinicians in their diagnosis.

Hereditary Dilated Cardiomyopathy: Recent Advances in Genetic Diagnostics.

Dilated cardiomyopathy (DCM) is the most common cause of heart failure in young adults and up to 50% of idiopathic DCM is thought to be caused by genetic mutations in candidate genes. Although a genetic diagnosis can confirm a clinical diagnosis of hereditary DCM, genetic testing has not been easily accessible due to genetic heterogeneity and complexity. Next-generation sequencing (NGS) technologies have recently been introduced, and genetic testing for multiple genes is currently available and more than 40 different genes have been associated with DCM. In Korea, the government has supported genetic diagnosis for patients with idiopathic DCM. When a targeted gene panel with NGS technology was used, the detection rate was about 40%. MYBPC3, LMNA, and MYH7 were the most frequently identified genes, and the pattern of causative genes was different from previous reports. In the analysis, a significant number of subjects (42.0%) had rare or novel unspecified variants in DCM candidate genes, which should be assessed as potential causative mutations. Developing a more comprehensive test panel with additional DCM genes and whole exome sequencing will improve the detection rate, and allow genetic testing to be an option for patients with idiopathic DCM. However, all genetic variations are not pathogenic mutations, and the majority of reported mutations in DCM are unique to a single family, which makes genetic data interpretation more difficult. Therefore, clinical features and familial history integration are needed to improve clinical decision making.

Detection and diagnosis of dilated cardiomyopathy and hypertrophic cardiomyopathy using image processing techniques

Major heart diseases like heart muscle damage and valvular problems are diagnosed using echocardiogram. Since the echocardiogram is an image or sequence of images with less information the cardiologist spends more time to predict or to make decision. Automating the detection and diagnosis of dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM) is a key enabling technology in computer aided diagnosis systems. In this paper, a system is proposed to automatically detect and diagnose dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM). This system performs denoising, enhancement, before left ventricular segmentation is carried out in the individual frames. Using the segmented left ventricle, the LV parameters like volume and ejection fraction (EF) are calculated and also the end-diastolic LV is extracted. The PCA and DCT features are obtained from the extracted end-diastolic LV and the classifiers BPNN, SVM and combined K-NN are used to classify the normal hearts, hearts affected with DCM and hearts affected with HCM. The PCA feature with BPNN classifier gives a highest overall accuracy of 92.04% in classifying normal and abnormal hearts. Experiments over 60 echocardiogram videos expose that the proposed system can be effectively utilized to detect and diagnose DCM and HCM.

Left Atrial Volume Index in Patients with Dilated Cardiomyopathy—Correlation with Left Ventricular Function

Background: The aim of this study was to determine the relation of left atrial (LA) volume and LA volume index with left ventricular function and to determine the association of duration of symptoms and left atrial volume index in patients with dilated cardiomyopathy. Materials and Methods: This was an observational, single centre study conducted in India. A total of 50 patients who were admitted to department of cardiology from July, 2008 to February, 2009 with diagnosis of dilated cardiomyopathy and an ejection fraction of <40% were included. Results: Of the 50 patients, 34 (68%) were males. 27 (54%) patients were in NYHA class II and 23 (46%) patients were in NYHA class III. LA volume was found to be ≥40 ml in all patients. LV function and LA volume were found to be correlated (r = -0.789, p < 0.01). Similarly, there was a correlation between LV function and LA volume index (r = -0.826, p < 0.01). There was no correlation between LA volume index and duration of symptoms (r = 0.04). Conclusion: It can be concluded that there is a strong inverse correlation between LA volume and left ventricular function and also between LA volume index and left ventricular function. The patients with NYHA class III were having larger left atrial volume than those with NYHA class II. Moreover, the duration of symptoms has no correlation with left atrial volume index.

Cardiac pathology in Irish wolfhounds with heart disease

ObjectivesTo evaluate gross and histopathologic lesions in Irish wolfhounds (IWs) with atrial fibrillation (AF) and/or primary dilated cardiomyopathy (DCM) in different stages of disease. MethodsTwenty-six formalin-fixed IW hearts were studied. Clinical diagnosis was based upon results of their most recent cardiovascular examinations including electrocardiography and echocardiography and categorized as normal (n = 4); preclinical (asymptomatic) DCM with AF (n = 6); DCM with congestive heart failure and AF (n = 4); AF with left ventricular reverse remodeling after DCM diagnosis (n = 3); AF without DCM (n = 7); and DCM with sinus rhythm (n = 2). All hearts were evaluated by one pathologist (HA) blinded to the clinical diagnosis. ResultsTen of 15 DCM hearts showed mild to moderate multifocal myocardial fibrosis with variable diffuse adipocyte infiltration within the left and right ventricular myocardium. In five DCM hearts, there were no histopathological findings identified. Right atrial appendages from AF dogs with and without DCM had significantly more myocardial fibrosis and adipocyte infiltration compared with normal hearts and compared to left atrial appendages. ConclusionsGross and histological findings in the ventricular myocardium of IWs with clinical diagnosis of DCM were variable; in some dogs, histopathology was normal. In IWs, the etiology of DCM might be different from that in other breeds with conditions causing functional impairment rather than evident histological changes. Right and left atrial appendages from IWs with AF displayed substantial pathology (interstitial fibrosis and adipocytes) most prevalent in the right atrial appendages which may be correlated to the pathogenesis of AF. These preliminary findings merit further study.

Characteristics of syncope in patients with dilated cardiomyopathy

BackgroundSyncope carries a poor prognosis among patients with dilated cardiomyopathy (DCM). ObjectivesTo assess the prevalence, describe the underlying mechanisms and to identify risk factors for syncope in patients with DCM. MethodsOne thousand six hundred and ten medical files of 897 patients with a diagnosis of DCM were reviewed. Patients with syncope were identified and their clinical and paraclinical profiles were compared to an equal number of age- and sex-matched patients with DCM without syncope. ResultsThirty patients (27 males) with an average age of 62.5 years were identified, corresponding to a prevalence of syncope of 3.3%. A cardiac origin of syncope was identified in 56% of patients (n=17): ventricular arrhythmias in 33% (n=10), and conduction disorders in 23% (n=7). Other mechanisms of syncope were neurally mediated in 7% (n=2) and orthostatic hypotension in 7% (n=2). In 30% of cases (n=9), the etiology was unidentified.There were no significant differences regarding the etiology of DCM, ejection fraction (35.3% vs 35.3%, p=1.0), NYHA class (mild or advanced, p=0.79) and associated conditions (hypertension, p=0.36; diabetes, p=0.75; atrial fibrillation, p=0.43; and dyslipidemia, p=0.33) between the two groups. However, among patients with syncope, patients with a noncardiac cause were more likely to have hypertension (61.53% vs 23.52%, p=0.08) and diabetes (46.15% vs 5.88%, p=0.03). ConclusionIn patients with DCM, syncope is a relatively rare finding. Cardiac causes (arrhythmias and conduction disorders) are responsible for the majority of cases. Risk factors for syncope in these patients remain to be determined.

Endomyocardial biopsy safety and clinical yield in pediatric myocarditis: An Italian perspective.

The objective of this investigation is to evaluate the safety, the impact of endomyocardial biopsy (EMB) results in myocarditis management and the incidence of different etiologies of myocarditis in a pediatric population. Although EMB is an established diagnostic tool to evaluate suspected myocarditis, there is lack of clear diagnostic and management guidelines for myocarditis in pediatric patients, particularly in infants. We performed a retrospective database review and subsequent outcomes analysis from five Italian pediatric cardiology centers to identify patients aged 0-18 years who underwent EMB for suspected myocarditis or inflammatory cardiomyopathy (ICMP) between 2009 and 2011. EMB was performed in 41 children, of which 16 were male. The population ranged between 16 days of age to 17 years (mean age at EMB = 5.2 ± 4.9 years). The overall incidence of EMB-related complications was 15.5% (31.2% in infants, and 6.8% in children > 1 year of age; P = 0.079) while the incidence of EMB-driven treatment changes was 29.2%. Histological examination together with PCR on heart biopsy specimens allowed an etiological diagnosis in 26/41 patients (63%). Among the 15 patients (36.5%) with diagnosis of dilated cardiomyopathy (DCM) 11 had idiopathic DCM. Finally, we found an overall incidence of death/cardiac transplantation of 24%. In a pediatric population with suspected myocarditis/ICMP, EMB was useful in confirming the diagnosis only in 41% of cases but showed an overall diagnostic power of 63%. As complications of EBM are not negligible, particularly in infants, the risk/benefit ratio should be taken into account in each patient.