Idiopathic Dilated Cardiomyopathy Research Articles

Reverse remodeling of mitral leaflets after medical treatment in recent-onset dilated cardiomyopathy.

The growth of mitral leaflets (MLs) adaptive to left ventricluar (LV) remodeling has been observed. However, the elasticity of MLs upon mechanical stimuli would be supposed if it shrinks with LV reverse remodeling (LVRR). Patients with idiopathic recent-onset dilated cardiomyopathy (RODCM) (n = 82) and 50 matched normal controls (NC) were prospectively enrolled. Echocardiography was performed at baseline and 6 months of follow-up for the anterior and posterior mitral leaflet (AML and PML) length, mitral annular dimension (MAD), and tenting height (TH). LVRR was measured as a ≥ 15% reduction in LV end-diastolic volume (LVEDV). After 6 months, LVRR was achieved in 69.5% of patients. The AML (28 ± 3 vs. 26 ± 3 mm, p = 0.004) and PML (19 ± 4 vs. 17 ± 3 mm, p < 0.001) decreased in length, as well as the MAD (31 ± 5 vs. 28 ± 5 mm, p = 0.001) and TH (10 ± 3 vs. 8 ± 2 mm, p < 0.001). Compared with the NC group, the AML and PML of the RODCM group were 16.7% and 35.7% longer at baseline and remained 8.3% and 21.2% longer at follow-up, respectively. The change in AML or PML correlated moderately with that in LVEDV (r = 0.487, p < 0.001; r = 0.516, p < 0.001, respectively). The AML and PML length decreased in the LVRR (+) subgroup (AML, 28 ± 3 vs. 26 ± 3 mm, p = 0.001; PML, 20 ± 4 vs. 16 ± 3 mm, p < 0.001), but remained the same in the LVRR (-) subgroup (27 ± 4 vs. 28 ± 4 mm, p = 0.318; 17 ± 3 vs. 17 ± 3 mm, p = 0.790). Enlarged MLs could reverse accompanied by LV reverse remodeling. This study provided the other facet of ML plasticity adaptive to mechanical stretching.

Metabolomic insights in advanced cardiomyopathy of chronic chagasic and idiopathic patients that underwent heart transplant

Heart failure (HF) studies typically focus on ischemic and idiopathic heart diseases. Chronic chagasic cardiomyopathy (CCC) is a progressive degenerative inflammatory condition highly prevalent in Latin America that leads to a disturbance of cardiac conduction system. Despite its clinical and epidemiological importance, CCC molecular pathogenesis is poorly understood. Here we characterize and discriminate the plasma metabolomic profile of 15 patients with advanced HF referred for heart transplantation – 8 patients with CCC and 7 with idiopathic dilated cardiomyopathy (IDC) – using gas chromatography/quadrupole time-of-flight mass spectrometry. Compared to the 12 heart donor individuals, also included to represent the control (CTRL) scenario, patients with advanced HF exhibited a metabolic imbalance with 21 discriminating metabolites, mostly indicative of accumulation of fatty acids, amino acids and important components of the tricarboxylic acid (TCA) cycle. CCC vs. IDC analyses revealed a metabolic disparity between conditions, with 12 CCC distinctive metabolites vs. 11 IDC representative metabolites. Disturbances were mainly related to amino acid metabolism profile. Although mitochondrial dysfunction and loss of metabolic flexibility may be a central mechanistic event in advanced HF, metabolic imbalance differs between CCC and IDC populations, possibly explaining the dissimilar clinical course of Chagas’ patients.

Successful pulmonary artery banding in an infant with idiopathic dilated cardiomyopathy and severe heart failure.

Successful pulmonary artery banding in an infant with idiopathic dilated cardiomyopathy and severe heart failure.

Left ventricular assist device temporary explantation as a strategy for infection control in a pediatric patient.

We report a case of temporary Berlin Heart EXCOR® explantation in a pediatric patient with idiopathic dilated cardiomyopathy who suffered an uncontrollable inflow cannulation site infection while on bridge-to-transplantation. Despite failure to thrive and catheter-related infections, once free of the device, the patient was cured of infection using systemic antibiotics and surgical debridement. The patient underwent EXCOR® reimplantation after four months, and is awaiting heart transplantation in stable condition. A life-threatening ventricular assist device-related infection may require device explantation under conditions that may not fulfill conventional explantation criteria despite risks. Temporary explantation can be an effective strategy if isolated systolic dysfunction is managed carefully.

Beating Heart Transplant Procedures Using Organs From Donors With Circulatory Death

The use of ex vivo normothermic organ perfusion has enabled the use of deceased after circulatory death (DCD) donors for heart transplants. However, compared with conventional brain death donation, DCD heart transplantation performed with ex vivo organ perfusion involves an additional period of warm and cold ischemia, exposing the allograft to multiple bouts of ischemia reperfusion injury and may contribute to the high rates of extracorporeal membrane oxygenation usage after DCD heart transplantation. To assess whether the beating heart method of DCD heart transplantation is safe and whether it has an acceptable rate of extracorporeal membrane oxygenation use postoperatively. This case series includes 10 patients with end-stage heart failure undergoing DCD heart transplantation at a single academic medical center from October 1, 2022, to August 3, 2023. Data were analyzed from October 2022 to August 2023. Using a beating heart method of implantation of the donor allograft. The main outcome was primary graft dysfunction necessitating postoperative initiation of mechanical circulatory support. Survival and initiation of mechanical circulatory support were secondary outcomes. In this case series, 10 consecutive patients underwent DCD heart transplantation via the beating heart method. Ten of 10 recipients were male (100%), the mean (SD) age was 51.2 (13.8) years, and 7 (70%) had idiopathic dilated cardiomyopathy. Ten patients (100%) survived, and 0 patients had initiation of extracorporeal membrane oxygenation postoperatively. No other mechanical circulatory support, including intra-aortic balloon pump, was initiated postoperatively. Graft survival was 100% (10 of 10 patients), and, at the time of publication, no patients have been listed for retransplantation. In this study of 10 patients undergoing heart transplantation, the beating heart implantation method for DCD heart transplantation was safe and may mitigate ischemia reperfusion injury, which may lead to lower rates of primary graft dysfunction necessitating extracorporeal membrane oxygenation. These results are relevant to institutions using DCD donors for heart transplantation.

Reduced mitochondrial pyruvate carrier expression in hearts with heart failure and reduced ejection fraction patients: ischemic vs. non-ischemic origin.

Mitochondrial pyruvate carrier (MPC) mediates the entry of pyruvate into mitochondria, determining whether pyruvate is incorporated into the Krebs cycle or metabolized in the cytosol. In heart failure (HF), a large amount of pyruvate is metabolized to lactate in the cytosol rather than being oxidized inside the mitochondria. Thus, MPC activity or expression might play a key role in the fate of pyruvate during HF. The purpose of this work was to study the levels of the two subunits of this carrier, named MPC1 and MPC2, in human hearts with HF of different etiologies. Protein and mRNA expression analyses were conducted in cardiac tissues from three donor groups: patients with HF with reduced ejection fraction (HFrEF) with ischemic cardiomyopathy (ICM) or idiopathic dilated cardiomyopathy (IDC), and donors without cardiac pathology (Control). MPC2 plasma levels were determined by ELISA. Significant reductions in the levels of MPC1, MPC2, and Sirtuin 3 (SIRT3) were observed in ICM patients compared with the levels in the Control group. However, no statistically significant differences were revealed in the analysis of MPC1 and MPC2 gene expression among the groups. Interestingly, Pyruvate dehydrogenase complex (PDH) subunits expression were increased in the ICM patients. In the case of IDC patients, a significant decrease in MPC1 was observed only when compared with the Control group. Notably, plasma MPC2 levels were found to be elevated in both disease groups compared with that in the Control group. Decreases in MPC1 and/or MPC2 levels were detected in the cardiac tissues of HFrEF patients, with ischemic or idiopatic origen, indicating a potential reduction in mitochondrial pyruvate uptake in the heart, which could be linked to unfavorable clinical features.

Characterization of Non-Ischemic Dilated Cardiomyopathy in a Native Tanzanian Cohort: MOYO Study.

Non-ischemic dilated cardiomyopathy (NIDCM) is a common cause of heart failure with progressive tendency. The disease occurs in one in every 2,500 individuals in the developed world, with high morbidity and mortality. However, detailed data on the role of NIDCM in heart failure in Tanzania is lacking. To characterize NIDCM in a Tanzanian cohort with respect to demographics, clinical profile, imaging findings and management. Characterization of non-ischemic dilated cardioMyOpathY in a native Tanzanian cOhort (MOYO) is a prospective cohort study of NIDCM patients seen at the Jakaya Kikwete Cardiac Institute. Patients aged ≥18 years with a clinical diagnosis of heart failure, an ejection fraction of ≤45% on echocardiography and no evidence of ischemia were enrolled. Clinical data, echocardiography, electrocardiography (ECG), coronary angiography and stress ECG information were collected from February 2020 to March 2022. Of 402 patients, n = 220 (54.7%) were males with a median (IQR) age of 55.0 (41.0, 66.0) years. Causes of NIDCM were presumably hypertensive n = 218 (54.2%), idiopathic n = 116 (28.9%), PPCM n = 45 (11.2%), alcoholic n = 10 (2.5%) and other causes n = 13 (3.2%). The most common presenting symptoms were dyspnea n = 342 (85.1%), with the majority of patients presenting with New York Heart Association (NYHA) Class III n = 195 (48.5%). The mean (SD) left ventricular ejection fraction (LVEF) was 29.4% (±7.7), and severe systolic dysfunction (LVEF <30%) was common n = 208 (51.7%). Compared with other forms of DCM, idiopathic DCM patients were significantly younger, had more advanced NYHA class (p < 0.001) and presented more often with left bundle branch block on ECG (p = 0.0042). There was suboptimal use of novel guidelines recommended medications ARNI n = 10 (2.5%) and SGLT2 2-inhibitors n = 2 (0.5%). In our Tanzanian cohort, the majority of patients with NIDCM have an identified underlying cause, and they present at late stages of the disease. Patients with idiopathic DCM are younger with more severe disease compared to other forms of NIDCM.

Current Insights and Novel Cardiovascular Magnetic Resonance-Based Techniques in the Prognosis of Non-Ischemic Dilated Cardiomyopathy.

Cardiac magnetic resonance (CMR) imaging has an important emerging role in the evaluation and management of patients with cardiomyopathies, especially in patients with dilated cardiomyopathy (DCM). It allows a non-invasive characterization of myocardial tissue, thus assisting early diagnosis and precise phenotyping of the different cardiomyopathies, which is an essential step for early and individualized treatment of patients. Using imaging techniques such as late gadolinium enhancement (LGE), standard and advanced quantification as well as quantitative mapping parameters, CMR-based tissue characterization is useful in the differential diagnosis of DCM and risk stratification. The purpose of this article is to review the utility of CMR in the diagnosis and management of idiopathic DCM, as well as risk prediction and prognosis based on standard and emerging CMR contrast and non-contrast techniques. This is consistent with current evidence and guidance moving beyond traditional prognostic markers such as ejection fraction.

Construction and evaluation of immune-related diagnostic model in patients with heart failure caused by idiopathic dilated cardiomyopathy

ObjectiveThe purpose of the study was to construct the potential diagnostic model of immune-related genes during the development of heart failure caused by idiopathic dilated cardiomyopathy.MethodGSE5406 and GSE57338 were downloaded from the GEO website (https://www.ncbi.nlm.nih.gov/geo/). CIBERSORT was used for the evaluation of immune infiltration in idiopathic dilated cardiomyopathy (DCM) of GSE5406. Differently expressed genes were calculated by the limma R package and visualized by the volcano plot. The immune-related genes were downloaded from Immport, TISIDB, and InnateDB. Then the immune-related differential genes (IRDGs) were acquired from the intersection. Protein–protein interaction network (PPI) and Cytoscape were used to visualize the hub genes. Three machine learning methods such as random forest, logical regression, and elastic network regression model were adopted to construct the prediction model. The diagnostic value was also validated in GSE57338.ResultsOur study demonstrated the obvious different ratio of T cell CD4 memory activated, T cell regulatory Tregs, and neutrophils between DCM and control donors. As many as 2139 differential genes and 274 immune-related different genes were identified. These genes were mainly enriched in lipid and atherosclerosis, human cytomegalovirus infection, and cytokine-cytokine receptor interaction. At the same time, as many as fifteen hub genes were identified as the IRDGs (IFITM3, IFITM2, IFITM1, IFIT3, IFIT1, HLA-A, HLA-B, HLA-C, ADAR, STAT1, SAMHD1, RSAD2, MX1, ISG20, IRF2). Moreover, we also discovered that the elastic network and logistic regression models had a higher diagnostic value than that of random forest models based on these hub genes.ConclusionOur study demonstrated the pivotal role of immune function during the development of heart failure caused by DCM. This study may offer new opportunities for the detection and intervention of immune-related DCM.

Clinical characteristics and outcome of cardiac resynchronization therapy for heart failure in National Hospital of Sri Lanka from year 2005 to 2020 – a retrospective observational study

BackgroundCardiac resynchronization therapy (CRT) has been a well-established treatment modality for moderate to severe left ventricular systolic dysfunction with left ventricular desynchrony. This is the pioneering study that analyses the cohort who underwent CRT implantation at the National Hospital of Sri Lanka (NHSL) in Colombo from 2005 to 2020.ObjectivesThis study was carried out to describe socio-demographic factors, improvements in clinical outcome (symptoms, electrocardiographic, and echocardiographic features), and post-CRT complications in the study population, as well as to determine the efficacy of CRT in heart failure.MethodA retrospective observational study was conducted on all the living patients who had undergone CRT implantation from 2005 to 2020. The data was gathered from all the consented patients who visited the device programming clinic using a physician-administered questionnaire and clinical records. Data was analyzed using SPSS 25, and significant statistics were assessed with the McNemer test, the Student T test, and the Chi-Squared test.ResultsThe study included 50 patients with a mean age of 52.82+/− 11.66 years and female predominance (56%, n = 28). Idiopathic dilated cardiomyopathy (50%, n = 25) was the leading etiological factor, followed by ischemic cardiomyopathy (28%, n = 14). Clinical symptoms have improved significantly with CRT implantation (p < 0.001). A significant improvement was found in NYHA functional class (p < 0.001, 95% CI = 0.072 to 0.284), QRS width (p < 0.001, 95% CI = 0.229 to 0.534), ejection fraction (p < 0.001, 95% CI = − 16.437 to − 8.504), and LV EDD (p < 0.001, 95% CI = 2.89 to 9.24). Post-CRT complications included lead malfunction (6%, n = 3) and chronic (14%, n = 7), bleeding or hematoma (2%, n = 1), pocket erosion or infection (6%, n = 3), and infective endocarditis (2%, n = 1).ConclusionAccording to the study, CRT significantly improves both clinical and functional outcomes in patients with moderate to severe heart failure.

Intestinal microbiota and metabolome perturbations in ischemic and idiopathic dilated cardiomyopathy

BackgroundVarious clinical similarities are present in ischemic (ICM) and idiopathic dilated cardiomyopathy (IDCM), leading to ambiguity on some occasions. Previous studies have reported that intestinal microbiota appeared dysbiosis in ICM, whether implicating in the IDCM remains unclear. The aim of this study was to assess the alterations in intestinal microbiota and fecal metabolites in ICM and IDCM.MethodsICM (n = 20), IDCM (n = 22), and healthy controls (HC, n = 20) were enrolled in this study. Stool samples were collected for 16S rRNA gene sequencing and gas chromatography-mass spectrometry (GC–MS) analysis.ResultsBoth ICM and IDCM exhibited reduced alpha diversity and altered microbial community structure compared to HC. At the genus level, nine taxa including Blautia, [Ruminococcus]_torques_group, Christensenellaceae_R-7_group, UCG-002, Corynebacterium, Oceanobacillus, Gracilibacillus, Klebsiella and Citrobacter was specific to ICM, whereas one taxa Alistipes uniquely altered in IDCM. Likewise, these changes were accompanied by significant metabolic differences. Further differential analysis displayed that 18 and 14 specific metabolites uniquely changed in ICM and IDCM, respectively. The heatmap was generated to display the association between genera and metabolites. Receiver operating characteristic curve (ROC) analysis confirmed the predictive value of the distinct microbial-metabolite features in disease status. The results showed that microbial (area under curve, AUC = 0.95) and metabolic signatures (AUC = 0.84) were effective in discriminating ICM from HC. Based on the specific microbial and metabolic features, the patients with IDCM could be separated from HC with an AUC of 0.80 and 0.87, respectively. Furthermore, the gut microbial genus (AUC = 0.88) and metabolite model (AUC = 0.89) were comparable in predicting IDCM from ICM. Especially, the combination of fecal microbial-metabolic features improved the ability to differentiate IDCM from ICM with an AUC of 0.96.ConclusionOur findings highlighted the alterations of gut microbiota and metabolites in different types of cardiomyopathies, providing insights into the pathophysiological mechanisms of myocardial diseases. Moreover, multi-omics analysis of fecal samples holds promise as a non-invasive tool for distinguishing disease status.Graphical

Prognostic significance of right ventricular dysfunction in patients presenting with acute left-sided heart failure.

The prognostic value of right ventricular (RV) function in chronic heart failure (HF) has lately been well established. However, research on its role in acute heart failure (AHF) is sparse. This study comprised 195 patients, aged between 18 and 80years, with acute left-sided heart failure (HF) and a left ventricular ejection fraction (LVEF) < 50%. Patients with LVEF ≥ 50%, mechanical ventilatory or circulatory support, poor echocardiographic windows, prosthetic valves, congenital heart diseases, infective endocarditis, and/or life expectancy < 1year due to non-cardiac causes were excluded. The study participants' mean age was 57.7 ± 10.9years, and 74.9% were males. Coronary artery disease was present in 80.5% of patients. The mean LVEF was 31% ± 8.7. RV dysfunction (RVD), defined as tricuspid annular plane systolic excursion (TAPSE) < 17mm, RV S' < 9.5cm/s and/or RV fractional area change (FAC) < 35%, was identified in 48.7% of patients. The RV was dilated in 67.7% of the patients. RVD was significantly associated with a longer HF duration, atrial fibrillation, and idiopathic dilated cardiomyopathy. The primary outcome, a 6-month composite of cardiovascular death or hospitalization for worsening HF (HHF), occurred in 42% of the participants. Cardiovascular mortality and HHF occurred in 30.5% and 23.9% of the patients, respectively. The primary endpoint and longer CCU stays were significantly more common in patients with RVD than in those with normal RV function. RV dilatation was significantly associated with the primary outcome, whether alone or in combination with RVD. Multivariate regression analysis showed that only RV global longitudinal strain (GLS) independently predicted poor outcomes. RVD and RV dilatation strongly predict CV death and HHF in patients with AHF and LVEF < 50%. Multivariate analysis showed that RV GLS was the only predictor of a composite of CV death and HHF.

The Relationship Between Annual Airborne Pollen Levels and the Occurrence of Uterine Cancer, Cervical Cancer, Corpus Uteri Cancer, Prostate Cancer, Bladder Cancer, Stomach Cancer, Cancer of the Gallbladder and Bile Ducts, Malignant Lymphoma, and Cancer of Oral and Pharyngeal, and Laryngeal Cancer: A Retrospective Study Based on The National Registry Database of Cancer Incidence In Japan, 1975–2015

Background: In Japan, pollen counts increased between 1977 and 1987, including three peaks (1978- 1980, 1982, 1984-1986) coinciding with triphasic Kawasaki disease (KD) outbreaks. Epidemiological findings have been extensively accumulated that KD since 2003 and, from 2018 related specific intractable diseases such as systemic vasculitis, collagen diseases, inflammatory bowel diseases, idiopathic dilated cardiomyopathy and further from 2019 various cancers such as lung, breast, pancreatic, skin and kidney cancers may be correlated to pollen exposure (PE). Methods and results: To elucidate the effects of PE on occurrence of other cancers, we evaluated the annual occurrence of disorders in relation to pollen counts using data from a national database. Specifically, we evaluated the occurrence of uterine cancer, cervical cancer, corpus uteri cancer, prostate cancer, bladder cancer, stomach cancer, cancer of gallbladder and bile ducts (GBB), malignant lymphoma (ML), oral and pharyngeal cancer (o-phar. cancers), laryngeal cancer. During 1975–2015, the 1978-80 and 1984-1986 peaks of pollen scatter was the earliest big peaks with which simultaneous increase in occurrence of uterine, cervical, bladder, stomach, GBB, o-phar. cancers and laryngeal cancers. Furthermore, simultaneous outbreaks of each cancer coincided with subsequent ten peaks of pollen scatter till 2015. Our results showed statistically significant correlations for o-phar cancers, laryngeal, prostate and stomach cancers between the annual number of newly registered patients (nRPs) in the patient-registry year and annual pollen levels in the same patient-registry year. Significant correlations were also shown between the number of nRPs in the patient-registry year and annual pollen levels measured 1 year (GBB), 2 years (prostate), 3 years (corpus uteri, stomach, ML), 5 years (uterine), 6 years (uterine, corpus uteri, prostate, bladder, GBB), 7 years (o-phar, laryngeal) and, 9 and 16 years (cervical) before the patient-registry year. Conclusion: We assume that cumulative effects of PE in many cases within about 6 years and more before the diagnosis of cancers might possibly trigger onset of cancers when cumulative effects of PE as environmental stress overwhelmed immunoreactive threshold. The authors would like to discuss the triggering effect of PE (the action of PE to induce a carcinogenic state in humans) on humans as a compromised host, in the preliminary stages of cancer development, in which human papillomavirus is thought to be involved in the pathogenesis.

Cardiogenic shock in idiopathic dilated cardiomyopathy patients: Red flag for myocardial decline

Cardiogenic shock in idiopathic dilated cardiomyopathy patients: Red flag for myocardial decline

Phenotypic differences between peripartum cardiomyopathy and idiopathic or familial cardiomyopathy in young women

Abstract Introduction Peripartum cardiomyopathy (PPCM) is a form of heart failure (HF) characterised by left ventricular (LV) dysfunction, which develops in previously healthy women towards the end of pregnancy or in the months following delivery. PPCM should be distinguished from underlying familial or idiopathic dilated cardiomyopathy (DCM), as management and outcomes of these conditions differ. Purpose We sought to investigate the phenotypic differences in women with PPCM as compared to those with DCM, the aetiology of which was either familial or idiopathic. Methods Sub-analysis was conducted on data collected by the African Cardiomyopathy and Myocarditis Registry Program (IMHOTEP), including 226 women from 3 sites in South Africa. Patients with a diagnosis of PPCM were compared to DCM (idiopathic or familial cardiomyopathy), with regards to their clinical presentation, echocardiography, and electrocardiography. Results Women with PPCM (n=132) were significantly younger than those with DCM (n=94) (29 [23-34] vs 38 [28-45] years). Both cohorts consisted mostly of patients of Black African descent (PPCM 66.7%, DCM 60.6%). A family history of HF was more commonly reported with DCM (36.6% vs 15%, p&amp;lt;0.001). Comorbidities, including hypertension, were uncommon in both groups. Two thirds of patients (66.4%) with PPCM had NYHA functional class III/IV at time of presentation, as compared to half of those with DCM (52.4%, p=0.14). Median systolic BP (113mmHg), diastolic BP (72mmHg) and pulse rate (91 bpm) did not differ between groups. On the ECG, there were significant differences in the intervals between patients with PPCM and DCM (PR interval of 152ms vs 168ms, p&amp;lt;0.001; QRS duration of 87ms vs 106ms, p&amp;lt;0.001; QTc by Bazett 429ms vs 451ms, p&amp;lt;0.001). Atrial fibrillation/flutter (5.5% vs 0.8%, p=0.083), left axis deviation (20.2% vs 2.6%, p&amp;lt;0.001) and left bundle branch block (22.6% vs 3.9%, p&amp;lt;0.001) occurred more frequently DCM compared to PPCM. Patients with PPCM more often manifested T wave inversion in the precordial leads (62.1% vs 46.8%, p=0.022). While there was no difference in LV systolic function (LVEF 28% [22-37]) between the groups, women with DCM had larger ventricles (LVEDD 63mm [57-69] vs 61mm [57-65], p=0.023), and atria (left atrial area 26.8 cm2 [21.9-30.2] vs 20.9 cm2 [18.2-26.1], p=0.002). However, LV thrombus was more frequently reported in PPCM compared to DCM (9.1% vs 2.1%, 0.032). Conclusion In this study, we demonstrate that compared to women with idiopathic and familial DCM, patients with PPCM were younger and had a number of phenotypic differences. The 12-lead ECG may be useful in the differentiation of both conditions. Accurate phenotyping of patients presenting with cardiomyopathy in the peripartum period may help to determine which patients require further investigations for DCM and influence the immediate and long-term care of these women.Figure 1

Does aetiology of dilated cardiomyopathy impact the outcome in Eastern Europe?

Abstract Introduction There are regional variations (West vs. East vs. North vs. South) in aetiology and outcomes in patients with cardiomyopathies according to EORP Registry. However, those preliminary observations have not been systematically verified. Here we report on the large cohort of dilated cardiomyopathy (DCM) patients managed in a tertiary centre in Eastern Europe. Purpose Analysis of all-cause mortality in DCM patients with different aetiology. Methods 500 DCM patients (aged 53.1±13.6 years, 81% male, LVEF 26.6±10.4%, LVEDd 65.9±10.3mm, symptoms duration 38.6±61.2 months) from 2010-2021 with complete baseline and follow-up data were included retrospectively. DCM aetiology was diagnosed according to medical documentation as: idiopathic, inflammatory, toxic: alcohol-induced or other (including chemotherapy and drug-induced), arrhythmic and familial or genetic (ref genetic). After mean follow-up (FU) of 45.6±31.0 months, the all-cause mortality and composite endpoint (all-cause mortality, heart transplant – HTX, left ventricle assist device implantation - LVAD) were assessed. Results Out of 500 DCM patients no clear aetiology was found in 41% of patients (idiopathic DCM). The most common was inflammatory DCM, followed by alcohol-induced, arrhythmic, and genetic DCM (Figure 1-A). The least common was toxic DCM (18 - after chemotherapy, 2 – drug-induced). During FU there were 97 (19%) patients with the following events: 88 (18%) patients died, 7 (1%) had LVAD and 15 (3%) had HTX (Figure 1-B). Statistically, all groups did not differ in terms of events (all p&amp;gt;0.05), however on the Kaplan-Meier plot patients with toxic DCM (chemotherapy or drug-induced) had the worst outcome while patients with inflammatory DCM had the best outcome during 6-years FU (Figure 1-C, 1-D). Conclusion More than one-third of DCM patients were diagnosed with idiopathic DCM. Toxic DCM was the second most prevalent aetiology and was diagnosed in nearly a quarter of patients. Alcohol-induced DCM was present in every fifth of patients. Although statistically no difference in outcome was found, according to Kaplan-Meier curves, patients with inflammatory DCM have the best prognosis and those with chemotherapy- or drug-induced – the worst.Figure 1.

Effect of ICD on patients with improved EF in idiopathic dilated cardiomyopathy

Abstract Background The efficacy of implantable cardioverter defibrillator (ICD) therapy in patients who had heart failure with improved ejection fraction (HFimpEF) above guidelines indication for ICD (&amp;gt;35%) during generator change is still controversial. This meta-analysis assesses the impact of ICD therapy in patients with HFimpEF with EF &amp;gt;35% and patient with NICM. Methods Databases were searched for studies reporting the association between ICD in patients with NICM and HFimpEF and ventricular arrhythmias (VA) and sudden cardiac death (SCD); including Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. The minimal follow up duration was one year. Results A total of 38 studies and 13,538 patients (5,829 with improved EF vs 7,709 with EF &amp;lt;35% during follow up) were included; mean follow up was 43 months (ranging between 12 to 74 months). Mean age was 63.5 and 75% were males. Patients with HFimpEF with ICD, wither alone or as part of CRT therapy, was associated with lower risk of VA and SCD (OR 0.39, 95% CI 0.32-0.47; P&amp;lt;0.01; annual rate 4.1 vs. 8%). Sub-analysis for patients with ICD for patient with NICM was associated with lower risk of VA and SCD (OR 0.25, 95% CI 0.1-0.62; P&amp;lt;0.01; annual rate 2.9 vs. 10.2%). (Figure) Conclusion Improved EF is associated with reduced VA but with still elevated risk in HFimpEF especially in NICM.

Veno-arterial extracorporeal membrane oxygenation as direct bridge to heart transplantation in a low and middle income country

Abstract Introduction The use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) as a direct bridge to heart transplantation (BTT) is not common in adults worldwide. BTT with ECMO is associated with increased early/mid-term mortality compared with other interventions. In low- and middle-income countries (LMIC), where no other type of short-term mechanical circulatory support is available, its use is widespread and increasingly used as rescue therapy in patients with cardiogenic shock (CS) as a direct bridge to heart transplantation (HT). Objective To assess the outcomes of adult patients using VA ECMO as a direct bridge to heart transplantation in a LMIC and compare them with international registries. Methods We conducted a single-center study analyzing consecutive adult patients requiring VA-ECMO as BTT due to refractory CS or cardiac arrest (CA) in a cardiovascular center in Argentina between January 2014 and December 2022. Survival and adverse clinical events after VA-ECMO implantation were evaluated. Results Of 86 VA-ECMO, 22 (25.5%) were implanted as initial BTT strategy and 52.1% finally underwent HT. Mean age was 46 years (SD 12); 59% were male. ECMO was indicated in all cases for CS and the most common underlying condition was coronary artery disease (30%), followed by idiopathic dilated cardiomyopathy (15%). Patient outcomes are described in Figure 1. Overall in-hospital mortality for VA ECMO as BTT was 50%. Survival to discharge was 83% in those who achieved HT and 10% in those who did not, p&amp;lt;0.001. In those who did not achieve HT, the main cause of death was haemorrhagic complications (44%), followed by thrombotic complications (33%). The median duration of VA ECMO was 6 days (IQR 3-16). There were no differences in the number of days on ECMO between those who received a transplant and those who did not. In the Spanish registry (Barge Caballero et al 2018), in-hospital survival after HT was 66.7%, the United Network of Organ Sharing registry (Fukuhara et al 2018) estimated post-transplant survival at 73.1% ± 4.4%, and in the French national registry (Jasserson et al 2016), 1-year post-transplant survival was 70% in the VA ECMO group. Conclusions In adult patients with cardiogenic shock, VA-ECMO as a direct BTT allowed successful HT in half of the patients. HT provided a survival benefit in listed patients on VA-ECMO. VA-ECMO can be used to bridge critically ill candidates directly to HT in a setting where no other circulatory support is available, as a salvage strategy with acceptable mortality in a high-volume specialized center. We present a single center experience with results comparable to registries in Spain, France and the United States.

Cassandra speaks: a case series of unanticipated subcutaneous ICD premature battery depletion in a single-centre experience

Abstract Background Subcutaneous ICDs (S-ICD) are a valuable option in sudden cardiac death prevention. The main advantage over conventional transvenous ICDs is the absence of intravascular hardware for patients without the need for cardiac stimulation, resynchronization therapy or anti-tachycardia pacing. The claim of reduced lead-related complications has on the contrary been challenged by recent warnings of unexpected lead fracture. Moreover, concerns related to premature battery depletion (PBD) leading to unanticipated device replacement are increasing. Purpose To evaluate retrospectively the incidence of unanticipated S-ICD premature battery depletion in a single-centre experience. Method 168 consecutive patients implanted with S-ICD from February 2015 to November 2022 in our tertiary cardiology centre were included in this study. 4 patients moved to other sites and were thus lost to follow-up, leaving a total of 164 patients. PBD was defined as the occurrence of battery depletion requiring generator replacement earlier than 60 months post-implantation in the absence of therapy being delivered, or as a result of manufacturer recommendations. Results Most patients were implanted for primary prevention (101 patients, 60%). The main aetiology was hypertrophic cardiomyopathy (47 patients, 28%), followed by arrhythmogenic (35, 21%) and dilated idiopathic cardiomyopathy (24, 14%). Mean age and left ventricular ejection fraction at baseline were 46±18yrs and 51±16%, respectively. Over a total follow up period of 44±25 months, at 58±17 months following implantation 19 (11,6%) patients needed early replacement due to PBD, while 2 (1.2%) patients had lead fracture after respectively 41 and 26 months, for a total of 12,8% of patients with system-related complications. In addition to those patients requiring early replacement due to PBD or lead fracture, two underwent S-ICD extraction due to infection. Analysis of freedom from unanticipated PBD per year of implantation showed higher rates in years 2016 and 2017, with 67% and 27% of all implanted patients, respectively (Figure 1). Conclusions In this study, the incidence of PBDs appear to be higher than reported in literature though confined to a limited device series. However, if on the contrary the trend should remain remarkably high, that would not only endanger patients health due to repeated replacements, but also pose a huge economic burden to health systems.

Long-term prognostic value of high-sensitivity cardiac troponin-I in patients with idiopathic dilated cardiomyopathy.

Our objective was to evaluate the long-term prognostic value of high-sensitivity cardiac troponin-I (hs-cTn-I) in idiopathic dilated cardiomyopathy (DCM). First, patients were divided into an end-event group (n = 55) and a non-end-event group (n = 67). Then, patients were included in the subgroup analysis to compare the diagnostic value of brain natriuretic peptide (BNP) and hs-cTn-I in different populations. hs-cTn-I and BNP concentrations were higher in the end-event group. The Cox regression analysis indicated that high hs-cTn-I was a risk factor for poor long-term prognosis. Receiver operating characteristic analysis showed that the area under the curve (AUC) for hs-cTn-I to predict end events was 0.751, and the AUC for BNP was 0.742. The correlation analysis suggested that hs-cTn-I was related to the percentage change in left ventricular internal diameter at end-diastolic and left ventricular ejection fraction. Subgroup analysis showed that compared with BNP, hs-cTn-I was more suitable for predicting end events in patients with preserved renal function (AUC: 0.853 vs 0.712, P = 0.04). In conclusion, hs-cTn-I is a potential biomarker for evaluating long-term prognosis in idiopathic DCM, and its predictive value is higher than that of BNP in patients with preserved renal function.