Novel Predictors of Left Ventricular Reverse Remodeling in Individuals With Recent-Onset Dilated Cardiomyopathy

Kubánek, Miloš; Šramko, Marek; Malušková, Jana; Kautznerová, Dana; Weichet, J.; Lupínek, Petr; Vrbská, Jana; Málek, I; Kautzner, Josef

doi:10.1016/j.jacc.2012.07.072

Cited by 133 publications

(127 citation statements)

References 28 publications

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“…158,159 In addition, it has recently been shown that low levels of BNP are predictive of recovery of left ventricular function in patients with heart failure. 150,160 In patients with heart failure, increases in MR-proANP and copeptin are associated with an increased risk of death or transplantation although the effect of copeptin does not seem to be independent of other biomarkers and clinical parameters.…”

Section: Natriuretic Peptidesmentioning

confidence: 99%

Novel Risk Markers and Risk Assessments for Cardiovascular Disease

Thomas

Lip

2017

Circulation Research

117

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Abstract:The use of risk markers has transformed cardiovascular medicine, exemplified by the routine assessment of troponin, for both diagnosis and assessment of prognosis in patients with chest pain. Clinical risk factors form the basis for risk assessment of cardiovascular disease and the addition of biochemical, cellular, and imaging parameters offers further refinement. Identifying novel risk factors may allow greater risk stratification and a steady, but gradual progression toward precision medicine. Indeed, the generation of data in this area of research is explosive and when combined with new technologies and techniques provides the potential for more refined, targeted approaches to cardiovascular medicine. Although discussing the most recent developments in this field, this review article aims to strike a balance between novelty and validity by focusing on recent large samplesize studies that have been validated in a separate cohort in most cases. Risk markers related to atherosclerosis, thrombosis, inflammation, cardiac injury, and fibrosis are introduced in the context of their pathophysiology. Rapidly developing new areas, such as assessment of micro-RNA, are also explored. Subsequently the prognostic ability of these risk markers in coronary artery disease, heart failure, and atrial fibrillation is discussed in detail. ( addition to these roles in the pathogenesis of coronary artery disease, lipid-related molecules have been identified to be markers of inflammation and oxidative stress (Table 1). Thrombosis-Related Risk MarkersAfter atherosclerotic plaque rupture, platelets adhere to exposed subendothelial components, such as collagen and von Willebrand factor, which promotes platelet activation and aggregation. 10 In addition, platelet activation is potentiated by exposure to released soluble agonists, such as thrombin and ADP.10 Activated platelets then further release ADP, which acts on platelet P2Y 12 ADP receptors and has a central role in amplifying the response of platelets to the initial stimulus. 10 Platelet reactivity to various agonists, including ADP, has been studied extensively in the context of acute coronary syndrome (ACS; Table 2). 11 The VerifyNow and Multiplate pointof-care tests allow for the measurement of platelet aggregation in response to stimulation, and it has been shown that high platelet reactivity is associated with adverse cardiovascular events. 26 Platelet microparticles are released on platelet activation, and their role in cardiovascular disease is an area of active investigation (Table 2). 15 Circulating microparticles are released from cells undergoing activation or apoptosis and are a type of small plasma membrane vesicle that retain defined properties from their original cell lineage. 15 Platelet activation and aggregation lead to the activation of the coagulation cascade and the formation of a stable crosslinked fibrin clot. The balance between prothrombotic factors and endogenous fibrinolysis determines whether the thrombus propagates or instead proceeds to dis...

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Section: Natriuretic Peptidesmentioning

confidence: 99%

Novel Risk Markers and Risk Assessments for Cardiovascular Disease

Thomas

Lip

2017

Circulation Research

117

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“…Our findings are in line with those of 2 recent CMR studies that have investigated the capacity of LGE in predicting LV remodeling in patients with recent-onset nonischemic cardiomyopathy. In a study including 44 patients, Kubanek et al 11 demonstrated that a lower extent of LGE at baseline CMR was an independent predictor of LV-RR at 12 months. However, in this study, one third of patients had increased troponin at study entry, and endomyocardial biopsy revealed myocardial inflammation and genomes of cardiotropic viruses in 34% and 66% of patients, respectively, indicating an inflammatory or viral cause of LV dysfunction in a sizeable number of cases.…”

Section: Discussionmentioning

confidence: 99%

“…Two recent studies reported that late gadolinium enhancement (LGE) detected by cardiovascular magnetic resonance (CMR) may be a useful marker for predicting LV-RR in patients with nonischemic cardiomyopathy. 10,11 However, these studies had a…”

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confidence: 99%

Myocardial Fibrosis as a Key Determinant of Left Ventricular Remodeling in Idiopathic Dilated Cardiomyopathy

Masci

Schuurman

Barison

et al. 2013

Circ: Cardiovascular Imaging

142

110

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Background-In idiopathic dilated cardiomyopathy, there are scarce data on the influence of late gadolinium enhancement (LGE) assessed by cardiovascular magnetic resonance on left ventricular (LV) remodeling. Methods and Results-Fifty-eight consecutive patients with idiopathic dilated cardiomyopathy underwent baseline clinical, biohumoral, and instrumental workup. Medical therapy was optimized after study enrollment. Cardiovascular magnetic resonance was used to assess ventricular volumes, function, and LGE extent at baseline and 24-month follow-up. LV reverse remodeling (RR) was defined as an increase in LV ejection fraction ≥10 U, combined with a decrease in LV end-diastolic volume ≥10% at follow-up. ΔLGE extent was the difference in LGE extent between follow-up and baseline. LV-RR was observed in 22 patients (38%). Multivariate regression analysis showed that the absence of LGE at baseline cardiovascular magnetic resonance was a strong predictor of LV-RR (odds ratio, 10.857 [95% confidence interval, 1.844-63.911]; P=0.008) after correction for age, heart rate, New York Heart Association class, LV volumes, and LV and right ventricular ejection fractions. All patients with baseline LGE (n=26; 45%) demonstrated LGE at follow-up, and no patient without baseline LGE developed LGE at follow-up. In LGE-positive patients, there was an increase in LGE extent over time (P=0.034), which was inversely related to LV ejection fraction variation (Spearman ρ, −0.440; P=0.041). Five patients showed an increase in LGE extent >75th percentile of ΔLGE extent, and among these none experienced LV-RR and 4 had a decrease in LV ejection fraction ≥10 U at follow-up. Conclusions-In patients with idiopathic dilated cardiomyopathy, the absence of LGE at baseline is a strong independent predictor of LV-RR at 2-year follow-up, irrespective of the initial clinical status and the severity of ventricular dilatation and dysfunction. The increase in LGE extent during follow-up was associated with progressive LV dysfunction. (Circ Cardiovasc Imaging. 2013;6:790-799.)

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“…We often had difficulty defining the disease duration and found a statistical overlap between this parameter and having familial cardiomyopathy. Important predictors such as brain natriuretic peptide and magnetic resonance imaging, 28 as well as genetic analysis, were not available in the majority of patients, and thus could not be analyzed.…”

Section: Discussionmentioning

confidence: 99%

Predictors and Outcome of Sustained Improvement in Left Ventricular Function in Dilated Cardiomyopathy

Blechman

Arad

Nussbaum

et al. 2014

Clinical Cardiology

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BackgroundImprovement in the left ventricular ejection fraction (LVEF) may occur in patients with dilated cardiomyopathy (DCM).HypothesisThere are different implications of persistent versus transient improvement in LVEF among DCM patients receiving contemporary therapy.MethodsWe studied 188 patients with nonischemic DCM. Persistent improvement in LVEF (PIEF) was defined as LVEF increase by at least 10% compared to baseline, and found in 2 separate echo‐Doppler exams performed at least 12 months apart. Increased LVEF in echo 2, which was not sustained in echo 3, was defined as transient improvement in LVEF (TIEF).ResultsOver an average follow‐up of 6.8 years, PIEF occurred in 61 (33%) patients, predicting a better long‐term outcome (P < 0.001) in a combined end‐point comprising death, heart transplantation, or the need for a ventricular assist device. The TIEF group had an intermediate course and were closer to nonimprovers (P = 0.003 vs PIEF). Multivariate logistic regression identified the following independent predictors of PIEF: shorter disease duration, pregnancy‐associated disease, left ventricular hypertrophy, and baseline LVEF ≤25%. A score to predict PIEF assigned 1 point to each of the following: disease duration <3 years and no familial cardiomyopathy; pregnancy‐associated presentation; basal LVEF ≤25%; and left ventricular wall thickness ≥12. A score of ≥3 was present in 44% of the patients, reliably predicting PIEF in 91% (P = 0.01).ConclusionsPersistent improvement in LVEF is associated with improved long‐term prognosis. Baseline clinical parameters can be used to identify patients likely to demonstrate PIEF, thereby allowing tailored management in this population.

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Novel Predictors of Left Ventricular Reverse Remodeling in Individuals With Recent-Onset Dilated Cardiomyopathy

Abstract: Both CMR and serial BNP testing provide a better prediction of LVRR in recent-onset DCM than EMB results, other biomarkers, and the conventional methods of follow-up.

Cited by 133 publications

References 28 publications

Novel Risk Markers and Risk Assessments for Cardiovascular Disease

Novel Risk Markers and Risk Assessments for Cardiovascular Disease

Myocardial Fibrosis as a Key Determinant of Left Ventricular Remodeling in Idiopathic Dilated Cardiomyopathy

Predictors and Outcome of Sustained Improvement in Left Ventricular Function in Dilated Cardiomyopathy

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