Clinical importance of late gadolinium enhancement at right ventricular insertion points in otherwise normal hearts.

Late gadolinium enhancement (LGE) has an established prognostic value in otherwise normal hearts, when detected with a subepicardial or intramyocardial pattern; nevertheless, the clinical relevance of isolated right ventricular insertion point (RVIP) LGE is yet to be defined. From a retrospectively identified cohort of 2000 consecutive patients undergoing CMR, we selected 420 patients according to study's inclusion and exclusion criteria (270 males, mean age 38 ± 17 years) with apparently normal hearts: besides 36 patients with non-ischemic pattern LGE (other-LGE group), we found isolated RVIP-LGE in 44 patients and absence of LGE (no-LGE group) in 340 patients. Clinical follow-up was performed for a median of approximately 6 years. Primary composite endpoint included cardiac death, resuscitated cardiac arrest, and appropriate implantable cardiac defibrillator shock. Prevalence of cardiac events was significantly lower in RVIP-LGE than in the other-LGE group (p = 0.006). Kaplan Meier curve analysis demonstrated no significant differences between patients with RVIP-LGE and no-LGE for the primary endpoint. On contrast, patients with other-LGE had worse prognosis than those with RVIP-LGE or no-LGE (p < 0.0001). RVIP-LGE in subjects without additional evidence of cardiac damage does not convey worse prognosis when compared to subjects without LGE and it should not be considered a marker of disease. Its diagnostic and prognostic significance is to be considered irrelevant.

Prognostic Role of Cardiac Magnetic Resonance in Arrhythmogenic Right Ventricular Cardiomyopathy.

We sought to evaluate the prognostic role of cardiac magnetic resonance (CMR) in patients with definite, borderline and possible diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) as defined by the International Task Force (TF) in 2010. CMR was performed in 175 patients: 52 with definite, 50 with borderline and 73 possible ARVC. Abnormal-CMR was defined as the presence of ≥1 CMR abnormalities (including abnormalities of right ventricular and left ventricular wall motion, fat infiltration, late gadolinium enhancement, dilation and dysfunction of either ventricles). During the follow-up time 35 patients had hard cardiac events (sudden cardiac death, appropriate implantable cardioverter defibrillator shock and resuscitated cardiac arrest), and 34 of them occurred in patients with abnormal-CMR (negative predictive value = 96.9%). At the multivariate Cox-regression analysis LV involvement at CMR (fat infiltration and/or late gadolinium enhancement), and episode of nonsustained ventricular tachycardia (NSVT) were independent predictors of cardiac events in both the whole population (LV involvement: HR 3.69, 95% CI 1.57-8.65, p = 0.0002; NSVT: HR 5.8, 95% CI 2.82-11.9, p < 0.0001), and in the group of patients with definite ARVC (LV involvement: HR 3.03, 95% CI 1.15 to 8.02, p = 0.02; NSVT: HR 12.1, 95% CI 4.02-36.5, p < 0.0001). In conclusion, CMR evidence of LV involvement is a strong independent predictor of cardiac events in patients with definite, borderline or possible ARVC diagnosis. Abnormal CMR has very high negative predictive value for hard cardiac events.

The biological effect of pharmacological treatment on dimethylaminohydrolases (DDAH-1) and cationic amino acid transporter-1 (CAT-1) expression in patients with acute congestive heart failure.

AIM: Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide (NO) which plays an important role in controlling vascular tone and regulates the contractile properties of cardiac myocytes. The aim of this study was to investigate the effect of pharmacological treatment on symmetric dimethylarginine (SDMA), ADMA and arginine plasma concentrations in patients with acute congestive heart failure (ACHF) through the evaluation of type-1 system cationic amino acid transporter-1/type 1 dimethylarginine dimethylaminohydrolases-1 (CAT-1/DDAH-1). METHODS AND RESULTS: 25 hospitalized cardiology patients with symptomatic acute congestive HF (NYHA Class III-IV) and impaired left ventricular (LV) function (ejection fraction<35%) were included in the study. ADMA, SDMA, and arginine plasma concentrations were assessed before and after pharmacological treatment by high performance liquid chromatography. All patients received an adequate pharmacological treatment for ACHF. ADMA and SDMA plasma levels were significantly higher after pharmacological treatment respect to baseline values (pre-treatment) (0.75 vs 0.48; 1.31 vs 1.03; p<0.01). Arginine plasma concentration was significantly lower after therapy respect to baseline values (0.78 vs 0.99; p<0.01). This is associated more with the modulation of DDAH-1 protein than with of CAT-1 system transport. CONCLUSIONS: In patients with ACHF, acute renal impairment function and the modulation of metabolism and extracellular transport by the DDAH-1/CAT-1 system determine high ADMA and SDMA levels after therapy for acute congestive heart failure.