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1.
J Vet Intern Med ; 33(3): 1222-1231, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30924221

RESUMO

BACKGROUND: Restrictive cardiomyopathy (RCM) is a common primary cardiomyopathy of cats. However, little information is available regarding prognostic variables in large populations of cats with RCM. OBJECTIVES: To characterize the epidemiological, clinical, and echocardiographic features of cats with RCM and to document their survival times and risk factors for cardiac death (CD). ANIMALS: Ninety-two cats with RCM. METHODS: Retrospective study. Diagnosis of RCM was based on echocardiographic and Doppler criteria. Median survival time to CD and adjusted hazard ratios (HR) were estimated by the Kaplan-Meier method and multivariate Cox models, respectively. RESULTS: The feline population (median age [interquartile range], 8.6 years [4.1-12.4]; body weight, 4.0 kg [3.3-4.7]) included 83 cats (90%) with the myocardial RCM form and 9 (10%) with the endomyocardial fibrosis RCM form. Most RCM cats (64/92, 70%) were symptomatic at the time of diagnosis, with dyspnea related to congestive heart failure in 57 of 64 cats (89%). The median survival time of the 69 cats with the myocardial RCM form and available follow-up was 667 days (range, 2-3710 days) considering CD. Independent of age, biatrial enlargement, and arrhythmias, increase of the left atrium (LA)-to-aorta (Ao) ratio (hazard ration [HR], 2.5 per 0.5-unit increase; 95% confidence interval [CI], 1.5-4.2; P < .001) and presence of severe LA enlargement (end-diastolic LA : Ao ≥2; HR, 3.4; 95% CI, 1.3-8.7; P = .01) were significantly associated with shorter time to CD. CONCLUSIONS AND CLINICAL IMPORTANCE: Cardiac death is common in RCM cats, and LA enlargement seems independently associated with decreased survival time in these cats.


Assuntos
Cardiomiopatia Restritiva/veterinária , Doenças do Gato/diagnóstico por imagem , Doenças do Gato/epidemiologia , Ecocardiografia/veterinária , Animais , Cardiomiopatia Restritiva/diagnóstico por imagem , Cardiomiopatia Restritiva/epidemiologia , Cardiomiopatia Restritiva/patologia , Gatos , Fibrose Endomiocárdica/veterinária , Feminino , Insuficiência Cardíaca/veterinária , Masculino , Miocárdio/patologia , Prognóstico , Estudos Retrospectivos
2.
J Ultrasound Med ; 37(11): 2637-2645, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29603321

RESUMO

OBJECTIVES: The tissue motion of annular displacement provides an accurate and rapid assessment of left ventricular (LV) systolic function. However, it has rarely been used in patients with chronic constrictive pericarditis and restrictive cardiomyopathy. This study aimed to assess the differences in LV systolic function in patients with constrictive pericarditis and restrictive cardiomyopathy using tissue motion of annular displacement derived from speckle-tracking echocardiography. METHODS: Twenty-four patients with constrictive pericarditis, 24 with restrictive cardiomyopathy, and 25 healthy volunteers (controls) were enrolled. The septal and lateral mitral annular longitudinal displacements, displacement at the midpoint, and normalized midpoint displacement of the mitral ring were calculated. RESULTS: Mitral annular tracking and quantification of the tissue motion of annular displacement were achieved within 10 seconds. In patients with constrictive pericarditis, the lateral mitral annular longitudinal displacement, displacement at the midpoint, and midpoint displacement of the mitral ring were decreased, whereas the septal mitral annular longitudinal displacement was preserved compared to controls, indicating that the reduction of systolic function in constrictive pericarditis was caused by pericardial adhesion and calcium. In patients with restrictive cardiomyopathy, tissue motion of annular displacement was more reduced compared to patients with constrictive pericarditis and controls. The correlation between the septal mitral annular longitudinal displacement and left ventricular ejection fraction was 0.67 (P < .001). A cutoff value of 8.45 mm for the septal mitral annular longitudinal displacement could effectively differentiate constrictive pericarditis from restrictive cardiomyopathy with 95.2% sensitivity and 91.7% specificity. CONCLUSIONS: The tissue motion of annular displacement was decreased in patients with constrictive pericarditis, which indicated early impairment of longitudinal function in constrictive pericarditis; adhesion and calcium in the pericardium might account for the reduction. The septal mitral annular longitudinal displacement provides a fast and effective method for the assessment of LV systolic function in patients with constrictive pericarditis and restrictive cardiomyopathy.


Assuntos
Cardiomiopatia Restritiva/diagnóstico por imagem , Ecocardiografia/métodos , Pericardite Constritiva/diagnóstico por imagem , Cardiomiopatia Restritiva/patologia , Doença Crônica , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Pericardite Constritiva/patologia , Pericárdio/diagnóstico por imagem , Pericárdio/patologia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
4.
Circ Cardiovasc Genet ; 10(6)2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29212899

RESUMO

BACKGROUND: Restrictive cardiomyopathy (RCM) is a rare cardiomyopathy characterized by impaired diastolic ventricular function resulting in a poor clinical prognosis. Rarely, heritable forms of RCM have been reported, and mutations underlying RCM have been identified in genes that govern the contractile function of the cardiomyocytes. METHODS AND RESULTS: We evaluated 8 family members across 4 generations by history, physical examination, electrocardiography, and echocardiography. Affected individuals presented with a pleitropic syndrome of progressive RCM, atrioventricular septal defects, and a high prevalence of atrial fibrillation. Exome sequencing of 5 affected members identified a single novel missense variant in a highly conserved residue of FLNC (filamin C; p.V2297M). FLNC encodes filamin C-a protein that acts as both a scaffold for the assembly and organization of the central contractile unit of striated muscle and also as a mechanosensitive signaling molecule during cell migration and shear stress. Immunohistochemical analysis of FLNC localization in cardiac tissue from an affected family member revealed a diminished localization at the z disk, whereas traditional localization at the intercalated disk was preserved. Stem cell-derived cardiomyocytes mutated to carry the effect allele had diminished contractile activity when compared with controls. CONCLUSION: We have identified a novel variant in FLNC as pathogenic variant for familial RCM-a finding that further expands on the genetic basis of this rare and morbid cardiomyopathy.


Assuntos
Cardiomiopatia Restritiva/genética , Filaminas/genética , Predisposição Genética para Doença , Mutação/genética , Adulto , Idoso , Sequência de Aminoácidos , Sequência de Bases , Cardiomiopatia Restritiva/patologia , Família , Feminino , Filaminas/química , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo
6.
Vet Pathol ; 54(4): 669-675, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28622497

RESUMO

Canine parvovirus-2 (CPV-2) is nearly indistinguishable from feline panleukopenia virus (FPV) and is a well-known cause of viral myocarditis in young puppies; however, it is not known whether either FPV or CPV-2 naturally infects feline cardiomyocytes and causes myocarditis. Endomyocarditis (EMC) and left ventricular endomyocardial fibrosis (LVEF), clinically known as "endomyocardial restrictive cardiomyopathy," are important feline heart diseases suspected to have an infectious etiology. A continuum is suggested with EMC representing the acute reaction to an unknown infectious agent and LVEF the chronic manifestation of repair. The purpose of this study was to determine (1) whether there is natural parvovirus infection of the feline myocardium and (2) whether parvoviral infection is associated with feline EMC and/or LVEF. In a retrospective study, polymerase chain reaction and sequencing for the parvovirus VP1/2 gene was performed on archived heart tissue from cats with endomyocardial disease and controls. Similar methods were used prospectively on myocardial tissues from shelter-source kittens. Although 8 of 36 (22%; 95% confidence interval [CI], 11%-40%) shelter kittens had parvoviral DNA in myocardial tissue, VP1/2 DNA was not detected in 33 adult cases or 34 controls (95% CI, 0% to ∼11%). These findings were confirmed by in situ hybridization: adult cats did not have detectable parvovirus DNA, although rare intranuclear signal was confirmed in 7 of 8 shelter-source kittens. In kittens, parvovirus was not significantly associated with myocarditis, and in situ hybridization signal did not colocalize with inflammation. Although infection of cardiomyocytes was demonstrated in kittens, these data do not support a role for parvovirus in EMC-LVEF.


Assuntos
Cardiomiopatia Restritiva/veterinária , Vírus da Panleucopenia Felina , Panleucopenia Felina/patologia , Miocardite/veterinária , Animais , Cardiomiopatia Restritiva/patologia , Cardiomiopatia Restritiva/virologia , Gatos , Panleucopenia Felina/virologia , Feminino , Coração/virologia , Masculino , Miocardite/patologia , Miocardite/virologia , Miocárdio/patologia , Inclusão em Parafina/veterinária , Reação em Cadeia da Polimerase/veterinária , Estudos Retrospectivos
7.
Curr Cardiol Rep ; 19(5): 43, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28405937

RESUMO

PURPOSE OF REVIEW: Echocardiography is the mainstay in the diagnostic evaluation of constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM), but no single echocardiographic parameter is sufficiently robust to accurately distinguish between the two conditions. The present review summarizes the recent advances in echocardiography that promise to improve its diagnostic performance for this purpose. The role of other imaging modalities such as cardiac computed tomography, magnetic resonance imaging, and invasive hemodynamic assessment in the overall diagnostic approach is also discussed briefly. RECENT FINDINGS: A recent study has demonstrated improved diagnostic accuracy of echocardiography with integration of multiple conventional echocardiographic parameters in to a step-wise algorithm. Concurrently, the studies using speckle-tracking echocardiography have revealed distinct and disparate patterns of myocardial mechanical abnormalities in CP and RCM with their ability to distinguish between the two conditions. The incorporation of machine-learning algorithms into echocardiography workflow permits easy integration of the wealth of the diagnostic data available and promises to further enhance the diagnostic accuracy of echocardiography. New imaging algorithms are continuously being evolved to permit accurate distinction between CP and RCM. Further research is needed to validate the accuracy of these newer algorithms and to define their place in the overall diagnostic approach for this purpose.


Assuntos
Algoritmos , Técnicas de Imagem Cardíaca , Cardiomiopatia Restritiva/diagnóstico por imagem , Pericardite Constritiva/diagnóstico por imagem , Cardiomiopatia Restritiva/patologia , Técnicas de Apoio para a Decisão , Diagnóstico Diferencial , Humanos , Pericardite Constritiva/patologia , Valor Preditivo dos Testes
8.
Cardiovasc Res ; 113(10): 1124-1136, 2017 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-28371863

RESUMO

Aims: The E143K (Glu → Lys) mutation in the myosin essential light chain has been associated with restrictive cardiomyopathy (RCM) in humans, but the mechanisms that underlie the development of defective cardiac function are unknown. Using transgenic E143K-RCM mice, we sought to determine the molecular and cellular triggers of E143K-induced heart remodelling. Methods and results: The E143K-induced abnormalities in cardiac function and morphology observed by echocardiography and invasive haemodynamics were paralleled by augmented active and passive tension measured in skinned papillary muscle fibres compared with wild-type (WT)-generated force. In vitro, E143K-myosin had increased duty ratio and binding affinity to actin compared with WT-myosin, increased actin-activated ATPase activity and slower rates of ATP-dependent dissociation of the acto-myosin complex, indicating an E143K-induced myosin hypercontractility. E143K was also observed to reduce the level of myosin regulatory light chain phosphorylation while that of troponin-I remained unchanged. Small-angle X-ray diffraction data showed a decrease in the filament lattice spacing (d1,0) with no changes in the equatorial reflections intensity ratios (I1,1/I1,0) in E143K vs. WT skinned papillary muscles. The hearts of mutant-mice demonstrated ultrastructural defects and fibrosis that progressively worsened in senescent animals and these changes were hypothesized to contribute to diastolic disturbance and to mild systolic dysfunction. Gene expression profiles of E143K-hearts supported the histopathology results and showed an upregulation of stress-response and collagen genes. Finally, proteomic analysis evidenced RCM-dependent metabolic adaptations and higher energy demands in E143K vs. WT hearts. Conclusions: As a result of the E143K-induced myosin hypercontractility, the hearts of RCM mice model exhibited cardiac dysfunction, stiff ventricles and physiological, morphologic, and metabolic remodelling consistent with the development of RCM. Future efforts should be directed toward normalization of myosin motor function and the use of myosin-specific therapeutics to avert the hypercontractile state of E143K-myosin and prevent pathological cardiac remodelling.


Assuntos
Cardiomiopatia Restritiva/genética , Mutação , Contração Miocárdica/genética , Miócitos Cardíacos/patologia , Cadeias Leves de Miosina/genética , Sarcômeros/patologia , Função Ventricular Esquerda/genética , Miosinas Ventriculares/genética , Remodelação Ventricular/genética , Actinas/metabolismo , Trifosfato de Adenosina/metabolismo , Animais , Cardiomiopatia Restritiva/metabolismo , Cardiomiopatia Restritiva/patologia , Cardiomiopatia Restritiva/fisiopatologia , Colágeno/metabolismo , Modelos Animais de Doenças , Metabolismo Energético , Feminino , Fibrose , Predisposição Genética para Doença , Humanos , Masculino , Camundongos Transgênicos , Miócitos Cardíacos/metabolismo , Miócitos Cardíacos/ultraestrutura , Cadeias Leves de Miosina/metabolismo , Fenótipo , Fosforilação , Sarcômeros/metabolismo , Sarcômeros/ultraestrutura , Miosinas Ventriculares/metabolismo
10.
Sci Rep ; 7: 39276, 2017 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-28098235

RESUMO

Pediatric restrictive cardiomyopathy (RCM) is a genetically heterogeneous heart disease with limited therapeutic options. RCM cases are largely idiopathic; however, even within families with a known genetic cause for cardiomyopathy, there is striking variability in disease severity. Although accumulating evidence implicates both gene expression and alternative splicing in development of dilated cardiomyopathy (DCM), there have been no detailed molecular characterizations of underlying pathways dysregulated in RCM. RNA-Seq on a cohort of pediatric RCM patients compared to other forms of adult cardiomyopathy and controls identified transcriptional differences highly common to the cardiomyopathies, as well as those unique to RCM. Transcripts selectively induced in RCM include many known and novel G-protein coupled receptors linked to calcium handling and contractile regulation. In-depth comparisons of alternative splicing revealed splicing events shared among cardiomyopathy subtypes, as well as those linked solely to RCM. Genes identified with altered alternative splicing implicate RBM20, a DCM splicing factor, as a potential mediator of alternative splicing in RCM. We present the first comprehensive report on molecular pathways dysregulated in pediatric RCM including unique/shared pathways identified compared to other cardiomyopathy subtypes and demonstrate that disruption of alternative splicing patterns in pediatric RCM occurs in the inverse direction as DCM.


Assuntos
Processamento Alternativo , Cardiomiopatia Restritiva/genética , Cardiomiopatia Restritiva/patologia , Regulação da Expressão Gênica , Adolescente , Adulto , Criança , Feminino , Perfilação da Expressão Gênica , Humanos , Masculino , Análise de Sequência de RNA , Adulto Jovem
11.
J Vet Med Sci ; 78(5): 781-4, 2016 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-26822001

RESUMO

Examination of our necropsy records for the period 2005 to 2014 yielded 41 cases of the endomyocardial form of restrictive cardiomyopathy among 327 cats with evidence of heart disease, and here, we reviewed their epidemiological and clinical features. The medical data obtained retrospectively included signalment, presenting complaints, findings of physical examination, results of various diagnostic tests, methods of treatment and survival times. Except for one Chinchilla Persian cat, all were domestic short-haired cats. The mean age at death was 7.3 ± 4.5 years (median, 6 years; range, 4 months to 19 years), and males accounted for 61% (25/41) of the total. Dyspnea was the most common clinical sign, being evident in 83% (35/41) of the cats. Hind limb paresis or paralysis due to aortic thromboembolism was evident in 41% (17/41). Arrhythmias of atrial origin were common. Echocardiography commonly revealed left atrial or biatrial enlargement with severe endocardial thickening of the left ventricle. Most of the affected cats had a poor outcome; the disease duration ranged from 1 to 977 days, and the median survival period was 30 days.


Assuntos
Cardiomiopatia Restritiva/veterinária , Doenças do Gato/epidemiologia , Animais , Cardiomiopatia Restritiva/epidemiologia , Cardiomiopatia Restritiva/patologia , Doenças do Gato/patologia , Gatos , Ecocardiografia/veterinária , Feminino , Coração/fisiopatologia , Masculino , Miocárdio/patologia , Estudos Retrospectivos
15.
Arch Biochem Biophys ; 573: 69-76, 2015 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-25813360

RESUMO

Diastolic dysfunction refers to an impaired relaxation and an abnormality in ventricular blood filling during diastole while systolic function is preserved. Cardiac myofibril hypersensitivity to Ca(2+) is a major factor that causes impaired relaxation of myocardial cells. The present study investigates the effect of the green tea extract catechins on myofibril calcium desensitization and restoration of diastolic function in a restrictive cardiomyopathy (RCM) mouse model with cardiac troponin mutations. Wild type (WT) and RCM mice were treated daily with catechin (epigallocatechin-3-gallate, EGCg, 50 mg/kg body weight) for 3 months. Echocardiography and cell based assays were performed to measure cardiac structure and flow-related variables including chamber dimensions, fraction shortening, trans-mitral flow patterns in the experimental mice. In addition, myocyte contractility and calcium dynamics were measured in WT and RCM cardiomyocytes treated in vitro with 5 µM EGCg. Our data indicated that RCM mice treated with EGCg showed an improved diastolic function while systolic function remained unchanged. At the cellular level, sarcomere relaxation and calcium decay were accelerated in RCM myocardial cells treated with EGCg. These results suggest that catechin is effective in reversing the impaired relaxation in RCM myocardial cells and rescuing the RCM mice with diastolic dysfunction.


Assuntos
Cálcio/metabolismo , Cardiomiopatia Restritiva/metabolismo , Catequina/análogos & derivados , Diástole/efeitos dos fármacos , Animais , Cardiomiopatia Restritiva/patologia , Cardiomiopatia Restritiva/fisiopatologia , Catequina/farmacologia , Tamanho Celular/efeitos dos fármacos , Eletrocardiografia , Camundongos Transgênicos , Miócitos Cardíacos/efeitos dos fármacos , Miócitos Cardíacos/fisiologia , Sarcômeros/efeitos dos fármacos , Sarcômeros/fisiologia , Troponina I/genética
16.
J Cardiovasc Med (Hagerstown) ; 16(8): 547-51, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25050531

RESUMO

Endomyocardial fibrosis is a disease of unknown cause, characterized by the development of restrictive cardiomyopathy. Although it is endemic in Africa, some cases have been described in Asia, South America and Europe, where a substantial unfamiliarity with this disease still exists. Moreover, differential diagnosis of endomyocardial fibrosis with other cardiomyopathies can be difficult, especially in asymptomatic patients and in initial stage of the disease. After initial echocardiographic analysis, the gold standard imaging technique is the cardiac magnetic resonance. Adjunctive diagnostic tools as endomyocardial biopsy can be considered in ambiguous cases and can help in patient management.


Assuntos
Fibrose Endomiocárdica/diagnóstico , Cardiomiopatia Restritiva/patologia , Fibrose Endomiocárdica/complicações , Fibrose Endomiocárdica/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Ultrassonografia
17.
Am J Emerg Med ; 32(7): 821.e5-7, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24745874

RESUMO

Restrictive cardiomyopathy (RCM) is an uncommon form of myocardial disorder characterized by diastolic dysfunction and increased myocardial stiffness. Endomyocardial fibrosis is one type of RCM hallmarked by formation of fibrous tissue on the endocardium. This report describes a case of RCM confirmed by autopsy in a young man who presented atypically with fever, vomiting, and delirium.


Assuntos
Cardiomiopatia Restritiva/complicações , Transtornos da Consciência/complicações , Delírio/complicações , Febre/complicações , Vômito/complicações , Cardiomiopatia Restritiva/patologia , Evolução Fatal , Humanos , Masculino , Adulto Jovem
18.
Cardiovasc Pathol ; 23(1): 28-34, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24035181

RESUMO

BACKGROUND: Spontaneously occurring small animal models of myocardial disease, closely resembling the human condition, have been reported for hypertrophic cardiomyopathy (in cats) and arrhythmogenic right ventricular cardiomyopathy (in cats and boxer dogs). Nonhypertrophied restrictive cardiomyopathy (RCM) is a well-recognized but relatively uncommon primary heart muscle disease causing substantial morbidity in humans. We describe RCM occurring in felines here as a potential model of human disease. METHODS: We used two-dimensional and Doppler echocardiography to define morphologic and functional features of RCM in 35 domestic cats (25 male; 10±4 years old) presenting to a subspecialty veterinary clinic. Ten underwent complete necropsy examination. Echocardiographic parameters of diastolic filling were compared to those in 41 normal controls. RESULTS: The 35 cats presented with congestive heart failure (n=32), lethargy (n=2), or syncope (n=1), associated with thromboembolism in 5 and supraventricular tachyarrhythmias in 8. During an average 4.4-year follow-up period, 18 died or were euthanized due to profound heart failure, and 3 died suddenly; survival from clinical presentation to death was 0.1 to 52 months. Echocardiographic and necropsy examination showed biatrial enlargement, nondilated ventricular chambers, and normal wall thicknesses and atrioventricular valves. Histopathology demonstrated disorganized myocyte architecture and patchy replacement myocardial fibrosis. Pulsed Doppler demonstrated restrictive physiology with increased early (E) mitral filling velocity (1.1±0.3 m/s) and peak E to peak late (A) flow ratios (4.3±1.2), reduced A filling velocity (0.3±0.1 m/s), and shortened mitral deceleration time (40.7±9.3 ms; all P<.001 vs. controls), with preserved left ventricular systolic function. CONCLUSIONS: A primary myocardial disease occurring spontaneously in domestic cats is remarkably similar to restrictive nondilated and nonhypertrophied cardiomyopathy in man and represents another potential animal model for human disease.


Assuntos
Cardiomiopatia Restritiva/veterinária , Doenças do Gato/patologia , Miocárdio/patologia , Animais , Autopsia/veterinária , Cardiomiopatia Restritiva/diagnóstico por imagem , Cardiomiopatia Restritiva/patologia , Cardiomiopatia Restritiva/fisiopatologia , Doenças do Gato/diagnóstico por imagem , Doenças do Gato/fisiopatologia , Gatos , Modelos Animais de Doenças , Progressão da Doença , Ecocardiografia Doppler de Pulso/veterinária , Eletrocardiografia/veterinária , Feminino , Fibrose , Humanos , Masculino , Contração Miocárdica , Valor Preditivo dos Testes , Radiografia , Especificidade da Espécie , Volume Sistólico , Fatores de Tempo , Função Ventricular Esquerda
19.
Circ Heart Fail ; 6(4): 676-84, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23733916

RESUMO

BACKGROUND: Endomyocardial biopsy (EMB) is often considered when the pathogenesis of heart failure cannot be determined by noninvasive testing. Uncertainty remains about the diagnostic and clinical use of EMB in various clinical scenarios. METHODS AND RESULTS: We examined the characteristics of a cohort of patients with unexplained heart failure who underwent EMB at a tertiary care medical center. We categorized each patient into a clinical scenario as outlined by the 2007 AHA/ACC/ESC guidelines and determined the number of times EMB provided a diagnosis or altered the clinical course. A total of 851 patients underwent EMB from 2000-2009. Overall, 25.5% of EMBs provided a diagnosis and 22.7% of EMBs changed clinical course. Heart failure associated with unexplained restrictive cardiomyopathy was the most common clinical scenario, comprising 33.6% (286/851) of EMBs, and 84 (29.4%) of these EMBs were diagnostic. EMB for unexplained heart failure of <2 weeks duration had a diagnostic yield at 35% (39/109). There were 4 uncommon scenarios where EMB had a high diagnostic and clinical yield. There were 16 complications for an overall rate of 1.9%. CONCLUSIONS: We confirm that EMB is useful in acute onset unexplained cardiomyopathy. We demonstrate a role for EMB in suspected infiltrative disease and in the management of rare clinical scenarios, such as suspected hypersensitivity myocarditis, anthracycline cardiomyopathy, cardiac tumors, and arrhythmogenic right ventricular dysplasia/cardiomyopathy. Our results suggest low use of EMB in chronic heart failure that responds to usual care.


Assuntos
Cardiomiopatia Restritiva/epidemiologia , Cardiomiopatia Restritiva/patologia , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/patologia , Adulto , Idoso , Biópsia , Comorbidade , Dilatação Patológica , Endocárdio/patologia , Feminino , Ventrículos do Coração/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Miocardite/epidemiologia , Miocardite/patologia , Miocárdio/patologia , Estudos Retrospectivos
20.
Am J Cardiol ; 112(3): 461-2, 2013 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-23672985

RESUMO

A 40-year-old woman from El Salvador presented with 3 months of abdominal pain and diarrhea followed by 2 weeks of atypical chest pain and exertional dyspnea and was diagnosed with eosinophilic endocarditis secondary to Strongyloides stercoralis infection. Transthoracic echocardiogram revealed apical masses in the left and right ventricles and a thickened posterior mitral valve leaflet and cardiac magnetic resonance imaging confirmed the presence of a left ventricular apical mass with diffuse subendocardial delayed enhancement consistent with endocardial fibrosis. In conclusion, eosinophilic endocarditis is a rare cause of restrictive cardiomyopathy characterized by endomyocardial fibrosis and apical thrombosis and fibrosis with frequent involvement of the posterior mitral valve leaflet.


Assuntos
Síndrome Hipereosinofílica/diagnóstico , Strongyloides stercoralis , Estrongiloidíase/diagnóstico , Adulto , Animais , Cardiomiopatia Restritiva/diagnóstico , Cardiomiopatia Restritiva/patologia , Cardiomiopatia Restritiva/cirurgia , Ecocardiografia , El Salvador/etnologia , Emigrantes e Imigrantes , Endocárdio/patologia , Endocárdio/cirurgia , Fibrose Endomiocárdica/diagnóstico , Fibrose Endomiocárdica/patologia , Fibrose Endomiocárdica/cirurgia , Feminino , Ventrículos do Coração/patologia , Ventrículos do Coração/cirurgia , Humanos , Síndrome Hipereosinofílica/patologia , Síndrome Hipereosinofílica/cirurgia , Hipertrofia Ventricular Esquerda/diagnóstico , Imagem por Ressonância Magnética , Miocárdio/patologia , Estrongiloidíase/patologia , Estrongiloidíase/cirurgia , Trombose/diagnóstico , Ultrassonografia Doppler , Estados Unidos
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