Dilated cardiomyopathy as a clinical syndrome: experience with nosological diagnosis with biopsy and treatment approaches


Cite item

Full Text

Abstract

Aim. To study possibility of nosological diagnosis in patients with dilated cardiomyopathy (DCMP) with use of myocardial biopsy.
Material and methods. The trial enrolled 62 patients (23 females) with DCMP syndrome (end diastolic left ventricular size > 5.5 cm, ejection fraction < 55%). Mean age of the patients was 46.0±12.8 years. The examination included diagnosis of viral infections (Herpes virus, parvovirus B19), measurement of anticardial antibodies titer, 99Tc-MIBI single photon emission computed tomography of the myocardium, multislice computed tomography, MRT of the heart, coronarography, morphological study of the myocardium (n = 20) with application of polymerase chain reaction (PCR) for H.simplex viruses of types 1, 2 and 6, herpes zoster, Epstein-Barr, cytomegalovirus, parvovirus B-19, adenoviruses. The control group (20 operated patients with valvular heart disease and coronary heart disease) was examined for viral genome in the blood and myocardium.
Results. Complex examination of DCMP patients showed the following distribution by nosological entuities: myocarditis (n = 41, 66.1%) including virus-positive (n = 14), primary DCMP (n = 16, 25.9%) including with non-compact myocarditis (NCM) in 3, with debute at delivery of the child - in 3. Arrhythmogenic right ventricular dysplasia combined with viral myocarditis (n = 2), genetic myopathy (n = 1) and Takayasu disease (n = 1) combined with NCM, isolated NCM (n = 1) were diagnosed in the rest cases. Morphological investigation of the myocardium was made in 20 patients: diagnosis of myocarditis and primary DCMP were made in 70% (including in 2 patients with CHD) and 20%. Detection of viral genome was 20 and 15% in the study and control group, respectively, in the myocardium - in 57.9 (test for parvovirus B19 was not made in 26%) and 65.0% (complete diagnosis).All the virus-positive patients with DCMP were diagnosed to have signs of active/borderline myocarditis. Diagnostic criteria and poor prognosis factors were defined.
Conclusion. The nosological diagnosis of DCMP was made in all the examinees basing on the complex of clinical, case history and device evidence. The diagnosis was morphologically verified in 33.9% patients. Treatment approaches are developed.

About the authors

Ol'ga Vladimirovna Blagova

Email: blagovao@mail.ru

A V Nedostup

E A Kogan

S L Dzemeshkevich

Yu V Frolova

V P Sedov

N V Gagarina

V A Sulimov

S A Abugov

E V Zaklyaz'minskaya

A E Donnikov

V V Kadochnikova

A G Kupriyanova

V A Zaydenov

L V Beletskaya

O V Blagova

I.M. Sechenov State Medical University, Moscow

I.M. Sechenov State Medical University, Moscow

A V Nedostup

I.M. Sechenov State Medical University, Moscow

I.M. Sechenov State Medical University, Moscow

E A Kogan

I.M. Sechenov State Medical University, Moscow

I.M. Sechenov State Medical University, Moscow

S L Dzemeshkevich

B.V. Petrovsky Russian Research Surgical Center, RAMS, Moscow

B.V. Petrovsky Russian Research Surgical Center, RAMS, Moscow

Yu V Frolova

B.V. Petrovsky Russian Research Surgical Center, RAMS, Moscow

B.V. Petrovsky Russian Research Surgical Center, RAMS, Moscow

V P Sedov

I.M. Sechenov State Medical University, Moscow

I.M. Sechenov State Medical University, Moscow

N V Gagarina

I.M. Sechenov State Medical University, Moscow

I.M. Sechenov State Medical University, Moscow

V A Sulimov

I.M. Sechenov State Medical University, Moscow

I.M. Sechenov State Medical University, Moscow

S A Abugov

B.V. Petrovsky Russian Research Surgical Center, RAMS, Moscow

B.V. Petrovsky Russian Research Surgical Center, RAMS, Moscow

E V Zaklyazminskaya

B.V. Petrovsky Russian Research Surgical Center, RAMS, Moscow

B.V. Petrovsky Russian Research Surgical Center, RAMS, Moscow

A E Donnikov

"DNA-technology" company, Moscow

"DNA-technology" company, Moscow

V V Kadochnikova

"DNA-technology" company, Moscow

"DNA-technology" company, Moscow

A G Kupriyanova

V.I. Shumakov Research Center for Transplantology and Artificial Organs Center

V.I. Shumakov Research Center for Transplantology and Artificial Organs Center

V A Zaidenov

V.I. Shumakov Research Center for Transplantology and Artificial Organs Center

V.I. Shumakov Research Center for Transplantology and Artificial Organs Center

L V Beletskaya

V.I. Shumakov Research Center for Transplantology and Artificial Organs Center

V.I. Shumakov Research Center for Transplantology and Artificial Organs Center

References

  1. Амосова E. Н. Кардиомиопатии. Киев: Книга Плюс; 1999.
  2. Gillum R. F. Idiopathic cardiomyopathy in the United States, 1970-1982. Am. Heart J. 1986; 111 (4): 752-755.
  3. Antunes M. J., Prieto D., Sola E. et al. Cardiac transplantation: five years' activity. Rev Port. Cardiol. 2010; 29 (5): 731-748.
  4. Aleksova A., Sabbadini G., Merlo M. et al. Natural history of dilated cardiomyopathy: from asymptomatic left ventricular dysfunction to heart failure - a subgroup analysis from the Trieste Cardiomyopathy Registry. J. Cardiovasc. Med. (Hagerstown) 2009; 10 (9): 699-705.
  5. Thiene G., Corrado D., Basso C. Cardiomyopathies: is it time for a molecular classification? Eur. Heart J. 2004; 25 (20): 1772-1775.
  6. Моисеев В. С., Киякбаев Г. К. Проблема классификации кардиомиопатий. Кардиология 2009; 49 (1): 65-70.
  7. Белявский Е. А., Заков К. А., Нарусов О. Ю. и др. Воспалительная кардиомиопатия: современное состояние проблемы. Тер. арх. 2011); 82 (8): 62-71.
  8. Luk A., Metawee M., Ahn E. et al. Do clinical diagnoses correlate with pathological diagnoses in cardiac transplant patients? The importance of endomyocardial biopsy. Can. J. Cardiol. 2009; 25 (2): e48-e54.
  9. Дземешкевич С. Л., Стивенсон Л. У. Дисфункции миокарда и сердечная недостаточность (классификация, диагностика, хирургическое лечение). М.: ГЭОТАР-Медиа; 2009.
  10. Brooks M. A., Sane D. C. CT findings in acute myocarditis: 2 cases. J. Thorac. Imag. 2007; 22 (3): 277-279.
  11. Axsom K., Lin F., Weinsaft J. W., Min J. K. Evaluation of myocarditis with delayed-enhancement computed tomography. J. Cardiovasc. Comput. Tomogr. 2009; 3 (6): 409-411.
  12. Caforio A. L., Calabrese F., Angelini A. et al. A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis. Eur. Heart J. 2007; 28 (11): 1326-1333.
  13. Kühl U., Pauschinger M., Noutsias M. et al. High prevalence of viral genomes and multiple viral infections in the myocardium of adults with "idiopathic" left ventricular dysfunction. Circulation 2005; 111 (7): 887-893.
  14. Kühl U., Pauschinger M., Seeberg B. et al. Viral persistence in the myocardium is associated with progressive cardiac dysfunction. Circulation 2005; 112 (13): 1965-1970.
  15. Shimomura H., Terasaki F., Hayashi T. et al. Autophagic degeneration as a possible mechanism of myocardial cell death in dilated cardiomyopathy. Jpn Сirc. J. 2001; 65 (11): 965-968.
  16. Tannous P., Zhu H., Johnstone J. L. et al. Autophagy is an adaptive response in desmin-related cardiomyopathy. Proc. Natl Acad. Sci. USA 2008; 105 (28): 9745-9750.
  17. Chimenti C., Pieroni M., Maseri A., Frustaci A. Histologic findings in patients with clinical and instrumental diagnosis of sporadic arrhythmogenic right ventricular dysplasia. J. Am. Coll. Cardiol. 2004; 43 (12): 2305-2313.
  18. Bowles N. E., Ni J., Marcus F., Towbin J. A. The detection of cardiotropic viruses in the myocardium of patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy. J. Am. Coll. Cardiol. 2002; 39 (5): 892-895.
  19. Frustaci A., Russo M. A., Chimenti C. Randomized study on the efficacy of immunosuppressive therapy in patients with virus-negative inflammatory cardiomyopathy: the TIMIC study. Eur. Heart J. 2009; 30 (16): 1995-2002.
  20. Andréoletti L., Lévéque N., Boulagnon C. et al. Viral causes of human myocarditis. Arch. Cardiovasc. Dis. 2009; 102 (6-7): 559-568.
  21. Dennert R., Crijns H. J., Heymans S. Acute viral myocarditis. Eur. Heart J. 2008; 29 (17): 2073-2082.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2011 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 

Address of the Editorial Office:

  • Novij Zykovskij proezd, 3, 40, Moscow, 125167

Correspondence address:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Managing Editor:

  • Tel.: +7 (926) 905-41-26
  • E-mail: e.gorbacheva@ter-arkhiv.ru

 

 © 2018-2021 "Consilium Medicum" Publishing house


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies