Spontaneous hemodynamic improvement or stabilization and associated biopsy findings in patients with congestive cardiomyopathy.

Figulla, Hans R.; Rahlf, G; Nieger, M; Luig, H.; Kreuzer, H

doi:10.1161/01.cir.71.6.1095

Cited by 152 publications

(34 citation statements)

References 28 publications

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“…In non-renal failure patients there is a wide variation in the natural history, which is inherent in the definition of the disorder as it has many causes [21], The majority of patients have a poor prognosis but some (13-39%) make a remarkable recovery or stabilize [22][23][24][25]. In our study 24% had improvement in cardiac function.…”

Section: Dilated Cardiomyopathymentioning

confidence: 78%

Outcome of Congestive Heart Failure, Dilated Cardiomyopathy, Hypertrophic Hyperkinetic Disease, and Ischemic Heart Disease in Dialysis Patients

et al. 1990

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Congestive heart failure in dialysis patients is associated with dilated cardiomyopathy, hypertrophic hyperkinetic disease and ischemic heart disease. To determine the natural history of these four diseases, 150 dialysis patients were prospectively followed for 3–5 years. The 2-year cumulative survival rate was 33% in those with recurrent or persistent congestive heart failure vs. 80% in dialysis patients without. Survival was significantly worse in patients with an echocardiographic diagnosis of dilated cardiomyopathy compared to patients with normal echocardiogram (2-year survival rate 67 vs. 90%). In hypertrophic hyperkinetic disease the 2-year survival rate was 30% after entry into the study, and 43 % after first admission with congestive heart failure. Symptomatic ischemic heart disease did not have an adverse impact on mortality when compared to those without ischemic heart disease. We conclude that congestive heart failure in dialysis patients has a bad prognosis. Its associated disorders include dilated cardiomyopathy and hypertrophic hyperkinetic disease, the latter being associated with a high mortality. As the prognosis for patients with overt ischemic heart disease was not different from patients without, it is likely that the underlying cardiomyopathy directly influenced survival.

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Section: Dilated Cardiomyopathymentioning

confidence: 78%

Outcome of Congestive Heart Failure, Dilated Cardiomyopathy, Hypertrophic Hyperkinetic Disease, and Ischemic Heart Disease in Dialysis Patients

et al. 1990

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“…5 The prognosis in classical dilated congestive cardiomyopathy has been said to be negatively related to ventricular size.9-12 Prognosis also has been said to be better in patients with preserved myofibrils in endomyocardial biopsy. 13 We have previously described an unusual, probably variant, form of dilated congestive cardiomyopathy termed "mildly dilated congestive cardiomyopathy" (MCDM), for lack of a better term. This was initially described in five heart transplant recipients with persistent clinical and hemodynamic features of end-stage congestive cardiomyopathy but with little or no left ventricular dilation.14 Additional unusual findings of MDCM were little or no myofibrillar loss on electron microscopy and a trend toward occurrence of dilated cardiomyopathy in other family members.…”

mentioning

confidence: 99%

Mildly dilated congestive cardiomyopathy. Use of prospective diagnostic criteria and description of the clinical course without heart transplantation.

et al. 1990

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Prognosis in classically described dilated congestive cardiomyopathy has been reported to be related to ventricular size. Mildly dilated congestive cardiomyopathy (MDCM) has been defined as end-stage heart failure of unknown etiology (New York Heart Association class IV, left ventricular ejection fraction less than 30%), occurring with neither typical hemodynamic signs of restrictive myopathy nor significant ventricular dilatation (less than 15% above normal range). The present study includes follow-up in 12 nontransplant patients. In the first 4 months after diagnosis, two patients improved and are living, and two showed cardiac dilation and clinical deterioration and died. Six of the remaining eight with persistent MDCM died (four with intractable heart failure and two, sudden deaths) without change in ventricular size before death, despite medical therapy over 20±8 months. Eight comparable transplanted patients with persistent MDCM demonstrated improved total survival by life table analysis (p<0.05). A family history of congestive cardiomyopathy was found in nine of 16 patients (56%) with persistent MDCM. Nontransplant patients were older (p<0.02), but other findings were similar in the two groups. Endomyocardial biopsies available in 14 of 16 cases showed little or no myofibrillar loss in spite of severe hemodynamic impairment. The degree of myofibrillar loss did not correlate with hemodynamic parameters but showed good correlation with left ventricular size, that is, five of six patients with no myofibrillar loss had normal ventricular size, whereas all eight patients with mild myofibrillar loss had mild cardiomegaly (p<0.002).Our current experience suggests a somewhat variable but negative prognosis after prospective diagnosis of MDCM, with poor survival in patients with persistence of the original diagnostic features during follow-up. Preservation of heart size in MDCM is probably related to lack of significant myofibrillar loss. Thus, irrespective of heart size or myofibrillar preservation on biopsy, heart transplantation should be strongly considered in MDCM if signs of severe cardiac dysfunction persist despite therapy. (Circulation 1990;81:506-517) V entricular dilation is considered the earliest and most distinguishing morphologic feature of congestive cardiomyopathy, which is often called "dilated cardiomyopathy."1-5 Lack of significant ventricular dilation is typically found in hypertrophic and in restrictive cardiomyopathies.1,24-8 Restrictive cardiomyopathy has also been termed "nondilated cardiomyopathy" by some authors to emphasize its morphological appearance and differentiate it from dilated

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“…Patients with a history of hypertension, systemic disorders or a known infection were excluded from the study. Left ventricular and coronary angiography and Swan-Ganz catheterization were performed according to standard methods [Figulla et al, 1985]. …”

Section: Cardiac Catheterization and Echocardiographic Evaluationmentioning

confidence: 99%

Low level myocardial parvovirus B19 persistence is a frequent finding in patients with heart disease but unrelated to ongoing myocardial injury

Lotze¹,

Egerer

Glück

et al. 2010

Journal of Medical Virology

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While myocardial parvovirus B19 (B19V), aside from enteroviruses (EV) and adenoviruses (ADV), has recently been found often in patients with myocarditis and idiopathic dilated cardiomyopathy (IDC), the pathogenetic significance of B19V genomes in those patients has not yet been sufficiently elucidated. In the present study, left ventricular endomyocardial biopsies from 24 patients with left ventricular ejection fraction (LVEF) below 55% due to IDC, and tissue from the right atrial appendage of 10 control patients undergoing bypass surgery with normal LVEF (>55%) were investigated for B19V, ADV, and EV genomes by specific nested polymerase chain reaction (PCR), by real time PCR or by reverse‐transcription PCR, respectively. The myocardial tissue samples from the 10 controls were analyzed each in three different virological laboratories for B19V. In the IDC group, the frequency of the myocardial virus genomes found in 54% (13/24) of the patients was as follows: B19V: 50% (12/24), EV: 8% (2/24), including one patient with B19V and EV, and ADV: 0% (0/24). For comparison, the prevalence of B19V genomes was between 30% and 60% in the control group as detected in three different laboratories, but all these control subjects were EV‐ and ADV‐negative. The number of B19V gene copies, however, was very low and similar both in the IDC and control group. In the majority of patients myocardial B19V persistence was associated with a low virus load irrespective of the underlying heart disease so that it may be of no importance in the pathogenesis of IDC. J. Med. Virol. 82:1449–1457, 2010. © 2010 Wiley‐Liss, Inc.

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Spontaneous hemodynamic improvement or stabilization and associated biopsy findings in patients with congestive cardiomyopathy.

Cited by 152 publications

References 28 publications

Outcome of Congestive Heart Failure, Dilated Cardiomyopathy, Hypertrophic Hyperkinetic Disease, and Ischemic Heart Disease in Dialysis Patients

Outcome of Congestive Heart Failure, Dilated Cardiomyopathy, Hypertrophic Hyperkinetic Disease, and Ischemic Heart Disease in Dialysis Patients

Mildly dilated congestive cardiomyopathy. Use of prospective diagnostic criteria and description of the clinical course without heart transplantation.

Low level myocardial parvovirus B19 persistence is a frequent finding in patients with heart disease but unrelated to ongoing myocardial injury

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