Reversible Dilated Cardiomyopathy Research Articles

PARTIALLY REVERSIBLE DILATED CARDIOMYOPATHY ASSOCIATED WITH AMPHOTERICIN B THERAPY

Abstract Background Amphotericin B (AmB) is an antifungal drug commonly used in a broad spectrum of infections, including leishmaniasis. Leishmaniasis, transmitted through insect bites, has cutaneous, mucocutaneous, or visceral (particularly liver and spleen) involvement. The main adverse effects of AmB are cardiotoxicity and nephrotoxicity, often reversible, but with yet unclear pathophysiology. Reversible dilated cardiomyopathy is a rare disease with very few cases described in the literature (less than 10). The Case A 41–year–old man with a silent cardiological history (only cocaine and alcohol abuse in past) is admitted for visceral leishmaniasis. Cardiological evaluation: LBBB in ECG (none previous available); no abnormality detected on ECOCG (EF 55%). Ten days after the AmB cycle, onset of worsening dyspnoea needing hospital treatment after a further two weeks for heart failure (HF). At ECOCG severe left ventricular dysfunction (EF 30%), no rise of cardiac enzymes was detected. Coronary angiography showed 50–75% stenosis on RCA and LAD, treated by angioplasty and stenting. Cardiac MRI showed: dilated left ventricle with diffuse biventricular hypokinesis (FE 16% left and 22% right), areas of LGE of non–ischemic appearance. HFrEF GDMTs were prescribed, with progressive clinical improvement over the next four weeks; at cardiac MRI performed one month later, partially recovery of biventricular function (FE sn 41% right 48%) was found. The ECG showed regression of LBBB. No myocardial biopsy was performed, so it is not possible to get to an unequivocal cardiac dysfunction’s cause. However, the time relationship between the use of AmB and the clinical findings evolution, consistently with the few literature available, suggests a probable diagnosis of AmB toxic cardiomyopathy. An ischaemic cause of the dysfunction is unlikely by the MRI feature and by coronary angiography findings. Literature data suggest that the presence of predisposing factors for cardiac dysfunction, rather than the duration of treatment or preparation used, is the most relevant factor in the development of AmB–related cardiomyopathy. It’s important to perform cardiac monitoring in all patients receiving AmB therapy. In all reported cases, cardiac function recovered substantially after cessation of AmB treatment.

Baseline profile and results of atrial fibrillation ablation in patients with arrhythmia-induced cardiomyopathy

Abstract Background Atrial fibrillation (AF) is known to trigger a reversible dilated cardiomyopathy referred as arrhythmia-induced CM (AiCM). However, it remains unclear why some patients are more prone to develop AiCM than others and there is scarce information about their clinical outcomes after AF ablation. Purpose We ought to find clinical and analytical predictors for the development of AiCM and recovery of LVEF in patients referred for AF ablation. Methods A prospective multicenter study of consecutive patients undergoing point-by-point radiofrequency (RF) catheter ablation between September 2016 and November 2021 was conducted. The low voltage areas and left atrial (LA) volume were analyzed offline on high density electroanatomical maps collected prior to RF ablation. Peripheral blood sample for biomarker analysis (Gal-3, FABP4 and sRAGE) were obtained at the time of the procedure. Results 803 consecutive patients were included, median age was 61 and 240 (30,81%) were women. AF pattern was paroxysmal in 254 (32,60%) and persistent in 534 (68,55%; of whom, long-standing persistent in 113 (14,51%) patients). The median follow-up period was 23.83 months [IQR 9 to 36]. The multivariate analysis revealed LA area, width of QRS segment, persistent AF and chronic kidney disease (CKD) as independent predictors for AiCM. Recurrence-free survival was not different amog both cohorts (Figure 1). The median increase in LVEF from baseline to the 6-month follow-up visit in patients with AiCM was 16% (CI 14.31–18.47) without changes in the non-AiCM group. The median LVEF previously to CA from patients in the AiCM group was 38% (IQR 30–45%) and after the procedure 57% (IQR 50–60%) [see figure 2]. Conclusions AiCM is characterized to have a particularly complex pathophysiology not fully understood thus far. Pulmonary vein isolation in patients is safe and suitable for patients that suffered from tachycardiomyopathy. We found that persistent AF and chronic kidney disease play a key role in its development. Neither peripheral blood biomarkers nor left atrial samples showed relevant association with its occurrence. Funding Acknowledgement Type of funding sources: None.

Arrhythmia-induced Cardiomyopathy: An Article Review

Arrhythmia is one of the significant reversible causes in patients with heart disease and left ventricular dysfunction. Tachycardia, atrial fibrillation, and premature ventricular contractions have indeed been related to arrhythmia-induced cardiomyopathy (CM), a reversible dilated CM. Effective arrhythmia suppression will entirely or partially recover ventricular function, lowering morbidity and mortality. However, the importance of arrhythmia-induced CM (ARiCM) is often underestimated in clinical practice because arrhythmia is often seen as a result rather than a cause of CM, leading in treatment delays and failure to increase the quality of life and better clinical outcomes. This article review aims to summarize the pathomechanisms, and a general approach to the management of ARiCM and its long-term outcomes. ARiCM can cause a variety of clinical signs, ranging from asymptomatic to severe heart failure symptoms. Electrocardiogram, 24 h Holter monitoring, echocardiography, and cardiac magnetic resonance are all recommended for diagnosis. More research is required to better understand the pathogenesis of ARiCM and to differentiate treatment alternatives to choose the ideal ARiCM management approach.

Tacrolimus-induced nonischemic dilated cardiomyopathy in a postrenal transplant recipient - A case report

We describe a case of nonischemic reversible dilated cardiomyopathy (DCM) due to tacrolimus in patient of live-related renal transplantation. Very few cases due to tacrolimus associated DCM has been reported in the literature, especially in the renal transplant recipient. With the growing use of tacrolimus in transplant medicine, this case report expands the literature of tacrolimus cardiotoxicity and can be useful for clinicians to evaluate and manage the case of DCM in the postrenal transplant recipient.

SAT-508 Oh My Thyrotoxic Heart! An Uncommon Presentation of High Output Heart Failure

High output heart failure is an extremely rare manifestation of thyrotoxicosis in patients without heart disease. Thyroid hormone has a potent metabolic, vascular, positive chronotropic and inotropic effects. Thyrotoxicosis is accompanied by a reduction in systemic vascular resistance and an obligatory increase in cardiac output to compensate high metabolic state. Most of the patients had completed or near completed recovery of cardiac function after treatment to euthyroid status, if cut in time.Case of 70 y/o female with past medical history of hypothyroidism, hypertension and chronic smoker, came to emergency room due to lightheadedness, weakness, shortness of breath, palpitations and acute bedridden for one week ago. Denied fever, nausea, vomiting or chest pain. On examination patient presented with 122bpm, 23rpm and normotensive. She was in acute respiratory distress requiring BiPAP. Lungs auscultation bilateral crackles, decrease sounds in the bases. Cardiac exam significant for tachycardia, lower extremity edema and JVD +. Laboratories significant for CKD stage 2, chronic anemia and hypoxemia. EKG no ST changes neither T depressions. CXR day #1 reported no cardiopulmonary disease. Basing in these she was admitted with Suspected Pulmonary Embolism. Well’s score was moderate risk; a Chest CTA and full anticoagulation were ordered. Later, venous duplex reported no DVT and D-dimer levels 1.65μg/ml. TSH levels significant decrease 0.0002mU/L and T4 1.800ng/dL. CXR Day#2 reported pulmonary edema and pleural effusion. ECHO2D moderate LVH and preserved systolic function. Patient referred her doctor recently increased thyroid medications from 50 to 100 mcg. Instead of presenting with pulmonary embolism, she has hyperthyroidal state causing cardiac failure. Levothyroxine, heparin and Chest CTA scan were cancelled. She was started in Atenolol and diuretics. Patient symptoms improved and was discharged home to be followed in the clinic. After one week, TSH levels were in 0.008mU/L and one month later in 3.032mU/L. She was started in Levothyroxine 50mcg, to maintain patient euthyroid state.This case illustrates that sometimes tachycardia and tachypnea are symptoms which frequently presents as baffling diagnostic problems. The association of thyrotoxicosis and cardiovascular morbidity is well established. Thyrotoxicosis most common cardiac manifestation is high output heart failure. Patients presenting with heart failure may have thyrotoxicosis as the underlying cause. Treatment of the thyrotoxicosis can restore normal heart function. Hyperthyroidal state may be take into consideration as a differential of tachycardia and tachypnea even if it’s not one of the common causes. Awareness of this presentation may help identify patients with reversible dilated cardiomyopathy and other complications.

514 Post-burn Malnutrition and Associated Cardiomyopathy

Abstract Introduction It is known that systolic dysfunction (dilated cardiomyopathy) may occur in a high percentage of patients with large TBSA burns. The reversible myocardial depression may be due to many factors: thermal injury, sepsis, severe malnutrition. Malnutrition and delayed wound healing may occur with a combination of primary and secondary protein-energy undernutrition. Methods Serial transthoracic and transesophageal echocardiographic parameters were measured during perioperative care (ejection fraction, fractional shortening, pericardial fluid) in 8 patients with evidence of malnutrition (low BMI, low albumin and prealbumin, muscle wasting) and a delayed presentation to the hospital. Initial echocardiography was performed post-injury day 30 -142; follow-up exams were performed in some patients at 2 years post-injury. Acutely-injured patients or those with sepsis were excluded. Results From 2015–2017, echocardiographic measurements were obtained in 8 patients, ages 7–21. The presenting TBSA ranged from 30–82% and included flame injury, electrical burns, and 1 case of pemphigus vulgaris. The initial ejection fraction ranged from 12–45% in patients with a BMI range of 10–25. The mean initial albumin was 2g/dL; the mean prealbumin was 9.5mg/dL. Two patients had mild to moderate pericardial effusions, which resolved after 1 month of proper nutrition. Selenium deficiency was noted in 1 patient. Four patients required perioperative short-term dobutamine. Conclusions Patients presenting with malnutrition and impaired wound healing all had evidence of cardiomyopathy; however, the degrees of systolic dysfunction varied significantly. BMI, albumin, and prealbumin all had a strong correlation with the degree of myocardial depression. Despite the lower ejection fractions, many patients maintained an adequate cardiac index and did not require inotropic medications. With time and adequate nutrition, cardiac function improved, although many remained with mild dysfunction in the first year. Applicability of Research to Practice This case series demonstrates the continued need for early recognition of malnutrition and cardiomyopathy in this patient population and the need for early intervention. Echocardiographic diagnosis may improve acute perioperative care. In addition, future studies are needed to determine the chronic cardiac effects of reversible dilated cardiomyopathy. Nutrition, refeeding, and perioperative management require a multidisciplinary team.

HYPOTHYROIDISM INDUCED CARDIOMYOPATHY

Dilated Cardiomyopathy (DCM) is usually an idiopathic disease with progressive and irreversible poor outcomes. Cases of “Reversible DCM” however secondary to hypothyroidism have been emerging recently. 39 year old female who presented with acute shortness of breath and severe dyspnea on

Reversible dilated cardiomyopathy caused by Wilms Tumour - a case report.

We are going to report a rare association of dilated cardiomyopathy with Wilms tumour in 2-year old female child. The patient was given neo-adjuvant chemotherapy leading to reduction in size of primary tumour with subsequent improvement in cardiac function. The patient subsequently underwent right nephrectomy with return of cardiac function to normal.

MON-404 Reversible Dilated Cardiomyopathy in a Severe Case of Cushing’s Disease

Introduction: Patients with Cushing’s syndrome (CS) present a higher mortality compared with the general population mainly due to cardiovascular and infectious diseases. Major forms of cardiac involvement include left ventricular hypertrophy, myocardial ischemia, and, more rarely, reversible dilated cardiomyopathy. This last condition is not fully understood, but it seems to be related to the direct action of cortisol, promoting increase of myocardial responsiveness to several factors involved in myocardial remodeling. Case report: A 18 yrs-old, male, was admitted with a four years clinical picture of progressive weight gain, moon face with plethora, proximal weakness with muscular atrophy, diffuse cutaneous violaceous striae, depressive symptoms and fragility fractures. Arterial hypertension started three years after. Two months before admission, he presented dyspnea, orthopnea and anasarca. At admission, tachycardia, tachypnea, arterial pressure of 170X100 mmHg, oxygen saturation of 83%, bilateral thoracic crackling, diffuse edema reaching inguinal region and BMI of 38.3 kg/m2. Hormonal analyses confirmed severe ACTH-dependent CS and pituitary MRI disclosed an expansible lesion of 1.6 cm suggestive of macroadenoma. Initial transthoracic echocardiography showed dilated left cavities, normal myocardial thickness but with moderate systolic dysfunction due to diffuse hypokinesia with ejection fraction (EF) of 45%. Patient was submitted to pharmacological approach to treat heart failure (HF) with furosemide, carvedilol, enalapril and spironolactone. Other etiologies for myocardiopathy such as infectious, autoimmune and metabolic diseases were excluded. Successful pituitary surgery was done in November 2016. The patient presented progressive improve of cardiac symptoms after all the treatments but mainly after pituitary surgery. Subsequent echocardiography 15 months after showed normal cardiac cavities, normal left ventricle and myocardial thickness and preserved global and segmental systolic function, EF of 56%. In the last evaluation (two years after surgery), the patient was using oral hydrocortisone twice/day and losartan Conclusion: Dilated cardiomyopathy is an uncommon clinical morbidity of CS. However, the immediate recognition of this condition and its effective treatment including control of hypercortisolism may reverse this life-threatening clinical condition

A CURIOUS CASE OF THE DILATED HEART: A CASE OF REVERSIBLE DILATED CARDIOMYOPATHY DUE TO SEVERE HYPOTHYROIDISM CAUSED BY HASHIMOTO THYROIDITIS

Dilated cardiomyopathy has varied etiology. Here we present a case of severe hypothyroidism presenting as reversible dilated cardiomyopathy. 64 yo African American female was referred to us for consideration for advanced heart failure therapies. She was in her usual state of health until 4 months

A reversible hypocalcemic dilated cardiomyopathy caused by primary hypoparathyroidism

Dilated cardiomyopathy (DCM) is characterized by dilation and impaired contraction of one or both ventricles. Affected patients have impaired systolic function and may or may not develop overt heart failure (HF). Prognosis is generally poor without heart transplantation. We experienced a case of a 10-year-old child with dilated cardiomyopathy (DCM) accompanied by undiagnosed primary hypoparathyroidism. In our case,aggressive management of hypoparathyroidism significantly improved the manifestations of DCM. The case presentation highlights the importance of considering hypoparathyroidism as a cause of reversible myocardial dysfunction.

Hypothyroidism as the cause of reversible dilated cardiomyopathy: A case report

Introduction. The causes of dilated cardiomyopathy can be divided into ischemic and nonischemic. Although the importance of thyroid hormones for proper functioning of the cardiovascular system is well known, dilated cardiomyopathy is a rare presentation of hypothyroidism. Case Report. This is a case report of a 38-year-old man admitted to the Intensive Cardiac Care Unit with signs and symptoms of advanced heart failure. Dilated cardiomyopathy was established by echocardiography, while blood test showed highly elevated levels of thyroid stimulating hormone and decreased levels of free triiodothyronine and free thyroxine. The ejection fraction was significantly improved with levothyroxine replacement therapy. Conclusion. Hypothyroidism should always be considered as the cause of dilated cardiomyopathy. Thyroid hormone tests should be performed in all patients with dilated cardiomyopathy.

Reversible dilated cardiomyopathy as a complication of adrenal cortex insufficiency: a case report

BackgroundCardiovascular manifestations associated with Addison’s disease are previously documented. We described a case of an 11-year-old girl who developed dilated cardiomyopathy as a complication to Addison’s disease. Glucocorticoid replacement therapy resulted in near-complete recovery of cardiac function. It is the first reported case of reversible cardiomyopathy as a complication of primary adrenal insufficiency in Syria.Case presentationAn 11-year-old Caucasian girl with no significant past medical history presented with abdominal pain, vomiting after meals, and a low-grade fever. A physical examination and laboratory evaluation suggested primary adrenal insufficiency. An echocardiogram showed changes consistent with dilated cardiomyopathy. Causes of primary adrenal insufficiency other than autoimmune were excluded.ConclusionsDilated cardiomyopathy is a rare complication of primary adrenal insufficiency. Proper treatment of adrenal insufficiency with glucocorticoid replacement therapy resulted in restoration of normal cardiac function.

REVERSIBLE NONISCHEMIC CARDIOMYOPATHY SECONDARY TO CENTRAL HYPOTHYROIDISM

SESSION TITLE: Cardiovascular Disease 1 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Thyroid hormones are well known to cause alterations in the cardiovascular hemodynamics. Hypothyroidism causes decreased contractility and cardiac output, bradycardia and increased systemic vascular resistance. This is secondary to changes in gene expression of enzymes involved in myocardial calcium shift, decrease beta adrenergic receptor expression and increase afterload induced by thyroid hormone deficiency. Although contractility and cardiac output are reduced in hypothyroidism, heart failure is rare due to the accompanying decrease in oxygen demand in the body. Here we are presenting a case of non-ischemic cardiomyopathy secondary to central hypothyroidism that improved with thyroid hormone replacement. CASE PRESENTATION: A 38-year-old female patient with history of adrenal insufficiency and central hypothyroidism secondary to panhypopituitarism secondary to Sheehan syndrome, presented with dyspnea and fatigue. She stated that she has not been taking her thyroid replacement therapy for a few months. On exam, BP was 128/100 and HR 66, she had distant heart sounds, no JVD and negative pulsus paradoxus, however, systolic BP dropped by 10 during inspiration. Labs showed TSH of 2 and fT4 of 0.16. EKG showed normal sinus rhythm without electrical alternans. Echo showed moderate pericardial effusion with RA collapse but no RV collapse, LVEF 30-35% and global hypokinesis of the left ventricle (Echo from 3 months earlier showed trivial pericardial effusion and LVEF 50%). She was started on her oral home dose of levothyroxine 125 mcg/day and had a nuclear stress test that showed no reversible perfusion defects. During her stay, she was hemodynamically stable and her symptoms started to improve. Repeat Echo showed marginal improvement in her LVEF with increase in RV systolic pressure. The size of the pericardial effusion was unchanged, however, respiratory variation in mitral and tricuspid inflow was less pronounced with less RA collapse. Later, her dyspnea and fatigue significantly improved and she was discharged home on oral levothyroxine 125 mcg/day. She was evaluated 5 weeks after discharge, with labs showing normal fT4 and Echo showing improved LVEF and decrease in the size of the pericardial effusion. DISCUSSION: Cardiac manifestations of hypothyroidism usually include dyspnea, fatigue, bradycardia, diastolic hypertension, edema and pericardial effusions. This is due to the effects of thyroid hormones deficiency on the heart and the vasculature. Systolic dysfunction is rare and only a few cases has been reported. Fortunately, it is usually reversible and improves with correcting the hypothyroidism. L-thyroxine (T4) is used to replace thyroid hormones and in this case, her home dose of 125 mcg/day was used. CONCLUSIONS: Thyroid function should be checked more frequently in patients presenting with cardiomyopathy specially if they have any concomitant signs and symptoms of hypothyroidism. Reference #1: Klein I, Ojamaa K. Thyroid Hormone and the Cardiovascular System. N Engl J Med. 2001 Feb 15;344(7):501-9. Reference #2: I Khochtali et al. Reversible dilated cardiomyopathy caused by hypothyroidism. Int Arch Med. 2011;4:20. Reference #3: Myung Do Seol et al. Dilated Cardiomyopathy Secondary to Hypothyroidism: Case Report with a Review of Literatures. J Cardiovasc Ultrasound. 2014 Mar; 22(1): 32-35. DISCLOSURES: No relevant relationships by Marsha Antoine, source=Web Response No relevant relationships by Housam Hegazy, source=Web Response No relevant relationships by Mili Shah, source=Web Response No relevant relationships by Bashar Sharma, source=Web Response No relevant relationships by Vikrant Tambe, source=Web Response

Dilated Cardiomyopathy due to Vitamin D Deficiency

Dilated cardiomyopathy, which mostly has an idiopathic etiology or is caused by genetic inheritance or infection, may cause irreversible congestive heart failure. Hypocalcemia is a rare etiology of reversible dilated cardiomyopathy. Cardiogenic shock related to hypocalcemic cardiomyopathy is a rare event. Here we report two cases with congestive heart failure who was diagnosed as having dilated cardiomyopathy secondary to hypocalcemia. After calcium and vitamin D replacement therapy, the patients showed improvement in left ventricular function. Hypocalcemia should be included in the differential diagnosis of dilated cardiomyopathy.

Reversible Dilated Cardiomyopathy: Into the Thaumaturgy of the Heart - Part 2

Dilated cardiomyopathy (DCM) is a genetic or acquired heart muscle disorder characterized by dilation and impaired contraction of one or both ventricles. In the acquired forms of the disease, if the pathogenic agent is persistent, undiagnosed or untreated, permanent ultrastructural and morphological changes may lead to irreversible dysfunction. Conversely, when DCM is promptly recognized and treated, the heart may show an extraordinary ability to recover from left ventricular (LV) systolic dysfunction. While much research in heart failure has focused on morbidity and mortality associated with persistent LV systolic dysfunction, relatively little attention has been devoted to this remarkable potential for recovery. In this two-part review we will focus on the most common types of reversible DCM. The second part will deal with chemotherapy-induced cardiomyopathy, alcohol- related cardiomyopathy, myocarditis and peripartum cardiomyopathy. Although diverse in etiopathogenesis, genetic background, therapeutic options and outcome, the forms of DCM characterized by reversible LV dysfunction share similar challenges in diagnosis and clinical management. The identification of pathways to recovery may show the way for novel therapeutic targets ultimately benefitting all cardiac patients.

Reversible Dilated Cardiomyopathy: Into the Thaumaturgy of the Heart—Part 1

Dilated cardiomyopathy (DCM) is a genetic or acquired heart muscle disorder characterized by dilation and impaired contraction of one or both ventricles. In the acquired forms of the disease, if the pathogenic agent is persistent, undiagnosed or untreated, permanent ultrastructural and morphological changes may lead to irreversible dysfunction. Conversely, when DCM is promptly recognized and treated, the heart may show an extraordinary ability to recover from left ventricular (LV) systolic dysfunction. While much research in heart failure has focused on morbidity and mortality associated with persistent LV systolic dysfunction, relatively little attention has been devoted to this remarkable potential for recovery. In this two-part review we will focus on the most common types of reversible DCM. The first part will deal with Tako-Tsubo cardiomyopathy, tachycardiainduced cardiomyopathy, metabolic DCM and recovery after Left ventricular assist device implantation. Although diverse in etiopathogenesis, genetic background, therapeutic options and outcome, the forms of DCM characterized by reversible LV dysfunction share similar challenges in diagnosis and clinical management. The identification of pathways to recovery may show the way for novel therapeutic targets ultimately benefitting all cardiac patients.

Reversible dilated cardiomyopathy in a case of primary hypothyroidism

Abstract Dilated cardiomyopathy associated with progressive and irreversible myocardial dysfunction has a poor prognosis. Few metabolic etiologies of dilated cardiomyopathy when identified are reversible and easily amenable to therapy. One of them is hypothyroidism as thyroid hormones have many effects on the heart. We report here a case of a young male who presented with dilated cardiomyopathy and was found to have primary hypothyroidism. His cardiac function improved on hormone replacement therapy. This case highlights the importance of recognition of the effects of thyroid disease on the heart and reversal of abnormal cardiovascular function on restoration of normal thyroid function.

The Emerging Role of Cardiovascular Magnetic Resonance Imaging in the Evaluation of Metabolic Cardiomyopathies.

The aim of this review is to discuss the role of Cardiovascular Magnetic Resonance (CMR) in the diagnosis, risk stratification, and follow-up of metabolic cardiomyopathies. The classification of myocardial diseases, proposed by WHO/ISFC task force, distinguished specific cardiomyopathies, caused by metabolic disorders, into 4 types: 1) endocrine disorders, 2) storage or infiltration disorders (amyloidosis, hemochromatosis and familial storage disorders), 3) nutritional disorders (Kwashiorkor, beri-beri, obesity, and alcohol), and 4) diabetic heart. Thyroid disease, pheochromocytoma, and growth hormone excess or deficiency may contribute to usually reversible dilated cardiomyopathy. Glucogen storage diseases can be presented with myopathy, liver, and heart failure. Lysosomal storage diseases can provoke cardiac hypertrophy, mimicking hypertrophic cardiomyopathy and arrhythmias. Hereditary hemochromatosis, an inherited disorder of iron metabolism, leads to tissue iron overload in different organs, including the heart. Cardiac amyloidosis is the result of amyloid deposition in the heart, formed from breakdown of normal or abnormal proteins that leads to increased heart stiffness, restrictive cardiomyopathy, and heart failure. Finally, nutritional disturbances and metabolic diseases, such as Kwashiorkor, beri-beri, obesity, alcohol consumption, and diabetes mellitus may also lead to severe cardiac dysfunction. CMR, through its capability to reliably assess anatomy, function, inflammation, rest-stress myocardial perfusion, myocardial fibrosis, aortic distensibility, iron and/or fat deposition can serve as an excellent tool for early diagnosis of heart involvement, risk stratification, treatment evaluation, and long term follow-up of patients with metabolic cardiomyopathies.

Reversible dilated cardiomyopathy associated with amphotericin B therapy

Amphotericin B (AmB) is commonly used to treat a broad spectrum of fungal infections and leishmaniasis. Its use is limited by numerous adverse effects. Reversible dilated cardiomyopathy associated with AmB is a rare disorder with only four previously reported cases, and all of them referring to patients who presented with a predisposing factor for heart failure. A previously healthy 45-year-old man with visceral leishmaniasis treated with AmB developed acute dilated cardiomyopathy. Other causes of heart failure as well-known predisposing factors for this condition were ruled out. As with previously reported cases, the cardiac function of our patient returned to normal shortly after. We describe the first case of dilated cardiomyopathy associated with the administration of AmB in a patient without any known predisposing factor for developing cardiac dysfunction. Available evidence suggests that AmB may induce cardiotoxicity. Further investigations are needed to clarify this issue.