Endomyocardial <scp>miR</scp>‐133a levels correlate with myocardial inflammation, improved left ventricular function, and clinical outcome in patients with inflammatory cardiomyopathy

Besler, Christian; Urban, Daniel J.; Watzka, Stefan B.; Lang, David J.; Rommel, Karl‐Philipp; Kandolf, Reinhard; Klingel, Karin; Thiele, Holger; Linke, Axel; Schuler, Gerhard; Adams, Volker; Lurz, Philipp

doi:10.1002/ejhf.579

Cited by 70 publications

(56 citation statements)

References 49 publications

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“…Although a broader use to improve the diagnosis of myocarditis and inflammatory cardiomyopathy has recently been proposed, many statements reserved the indications to endomyocardial biopsy for selected cases . In a patient with newly diagnosed DCM, endomyocardial biopsy is reasonable when there is a high probability of a specific diagnosis which can be confirmed only in myocardial samples and is amenable to therapy that has the potential to change the course of the disease . Examples of such scenarios include active myocarditis ( Figure ), the contemporary presence of a hypertrophic and dilated left ventricle (for example in end‐stage hypertrophic cardiomyopathy), cardiac amyloidosis, sarcoidosis, or haemochromatosis …”

Section: Specific Aspects In the Clinical Management Of Dilated Cardimentioning

confidence: 99%

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Evolving concepts in dilated cardiomyopathy

Merlo

Cannatà

Gobbo

et al. 2017

European J of Heart Fail

279

270

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Dilated cardiomyopathy (DCM) represents a particular aetiology of systolic heart failure that frequently has a genetic background and usually affects young patients with few co-morbidities. The prognosis of DCM has improved substantially during the last decades due to more accurate aetiological characterization, the red-flag integrated approach to the disease, early diagnosis through systematic familial screening, and the concept of DCM as a dynamic disease requiring constant optimization of medical and non-pharmacological evidence-based treatments. However, some important issues in clinical management remain unresolved, including the role of cardiac magnetic resonance for diagnosis and risk categorization and the interaction between genotype and clinical phenotype, and arrhythmic risk stratification. This review offers a comprehensive survey of these and other emerging issues in the clinical management of DCM, providing where possible practical recommendations.

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Section: Specific Aspects In the Clinical Management Of Dilated Cardimentioning

confidence: 99%

“…the course of the disease. 24,41,42 Examples of such scenarios include active myocarditis (Figure 2), the contemporary presence of a hypertrophic and dilated left ventricle (for example in end-stage hypertrophic cardiomyopathy), cardiac amyloidosis, sarcoidosis, or haemochromatosis. 10…”

Section: Baselinementioning

confidence: 99%

Evolving concepts in dilated cardiomyopathy

Merlo

Cannatà

Gobbo

et al. 2017

European J of Heart Fail

279

270

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“…15,17,18 Paraffin-embedded EMBs were stained with Masson's trichrome, reflecting myocyte necrosis, as well as interstitial fibrosis, and analyzed by light microscopy, as published. 17,19 Fibrotic and artifact areas were digitally marked on stained EMB sections.…”

Section: Emb Analysesmentioning

confidence: 99%

Plasma and Cardiac Galectin-3 in Patients With Heart Failure Reflects Both Inflammation and Fibrosis

Besler

Lang

Urban

et al. 2017

Circ: Heart Failure

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Background— Galectin (Gal)-3 is a β-galactoside-binding lectin and currently intensely studied as a biomarker in heart failure. Gal-3 also exerts proinflammatory effects, at least in extracardiac tissues. Objective of this study was to characterize the relationship of plasma and myocardial Gal-3 levels with cardiac fibrosis and inflammation in patients with nonischemic dilated cardiomyopathy and inflammatory cardiomyopathy (iCMP). Methods and Results— Endomyocardial biopsies and blood samples were obtained from patients with newly diagnosed cardiomyopathy and clinical suspicion of myocarditis. According to histopathologic findings, patients were classified as having dilated cardiomyopathy (n=40) or iCMP (n=75). Cardiac fibrosis was assessed histologically on endomyocardial biopsy sections. In patients with iCMP, myocardial Gal-3 expression significantly correlated with inflammatory cell count on endomyocardial biopsy ( r =0.56; P <0.05). In contrast, an inverse association was observed between myocardial Gal-3 expression and cardiac fibrosis in patients with iCMP ( r =−0.59; P <0.05). In patients with dilated cardiomyopathy, myocardial Gal-3 expression correlated with cardiac fibrosis on left ventricular biopsy ( P =0.63; P <0.01). Of note, in both groups, plasma Gal-3 levels did not correlate with myocardial Gal-3 levels or left ventricular fibrosis, whereas a positive correlation between plasma Gal-3 levels and inflammatory cell count on endomyocardial biopsy was observed in patients with iCMP. Conclusions— The present study suggests that myocardial Gal-3 can be considered as a possible marker for both cardiac inflammation and fibrosis, depending on the pathogenesis of heart failure. However, circulating concentrations of Gal-3 do not seem to reflect endomyocardial Gal-3 levels or cardiac fibrosis.

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“…In a phase 3 trial of adjuvant ipilimumab vs. placebo following complete resection of high‐risk stage III melanoma, one myocarditis death was reported in the ipilimumab group . Novel cardiac biomarkers may ultimately have a role in identifying patients at high risk for adverse outcomes . Treatment strategies employed to date include prompt discontinuation of the immunotherapy, high‐dose corticosteroids, and standard neurohormonal medical therapies for heart failure.…”

Section: Discussionmentioning

confidence: 99%

Immune‐related fulminant myocarditis in a patient receiving ipilimumab therapy for relapsed chronic myelomonocytic leukaemia

Berg

Vaduganathan

Nohria

et al. 2017

European J of Heart Fail

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Immune-related fulminant myocarditis in a patient receiving ipilimumab therapy 683 Figure 1 (a) Baseline electrocardiogram showing normal sinus rhythm and normal intervals. (b) Presenting electrocardiogram showing low voltage, sinus tachycardia, first degree atrioventricular block, and right bundle branch block. (c) Electrocardiogram obtained several hours into admission showing complete heart block with a wide ventricular escape.

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Endomyocardial miR‐133a levels correlate with myocardial inflammation, improved left ventricular function, and clinical outcome in patients with inflammatory cardiomyopathy

Abstract: The present study demonstrates that miR-133a levels correlate with macrophage infiltration, cardiac injury, improved LV function, and clinical outcome in patients with iCMP. miR-133a may serve as a potential novel biomarker and therapeutic target in human iCMP.

Cited by 70 publications

References 49 publications

Evolving concepts in dilated cardiomyopathy

Evolving concepts in dilated cardiomyopathy

Plasma and Cardiac Galectin-3 in Patients With Heart Failure Reflects Both Inflammation and Fibrosis

Immune‐related fulminant myocarditis in a patient receiving ipilimumab therapy for relapsed chronic myelomonocytic leukaemia

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