This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Obrador, D. Articles by Marrugat, J. Search for Related Content PubMed PubMed Citation Articles by Obrador, D. Articles by Marrugat, J.

Circulation, Vol 89, 2054-2061, Copyright © 1994 by American Heart Association

ARTICLES

Presence, evolving changes, and prognostic implications of myocardial damage detected in idiopathic and alcoholic dilated cardiomyopathy by 111In monoclonal antimyosin antibodies

D Obrador, M Ballester, I Carrio, C Moya, I Bosch, V Marti, L Berna, M Estorch, C Udina and J Marrugat
Department of Cardiology and Cardiac Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.

BACKGROUND: The clinical relevance of myocardial cell damage in dilated cardiomyopathy is uncertain. Myocardial uptake of 111In monoclonal antimyosin antibodies (MAA) was used to study myocardial damage in patients with idiopathic (IDC) and alcoholic (ADC) dilated cardiomyopathy and to assess its prognostic implications. METHODS AND RESULTS: MAA and echocardiographic studies were performed in 117 patients. Intensity of antibody uptake was measured by heart-to-lung ratio (HLR) (normal < 1.55). Studies were repeated in survivors and patients who did not receive a cardiac transplant. Follow-up extended up to 62 months (mean, 23 +/- 16 months). Eighty-eight patients with IDC showed a 77% prevalence of abnormal MAA. After acute-onset IDC, reduction of HLR (1.81 +/- 0.2 to 1.56 +/- 0.1) (P = .007) with improvement in ejection fraction (EF) (35 +/- 10% to 46 +/- 14%) (P = .018) was observed. No changes in HLR or EF were detected in patients with chronic stable IDC. Twenty-nine patients with ADC showed a lower prevalence (48%) of abnormal MAA studies than those with IDC (P = .003). HLR was higher in 13 active (1.78 +/- 0.3) than in 16 past consumers (1.49 +/- 0.2) (P = .019); in the former, HLR decreased to 1.44 +/- 0.2 (P = .012), and EF improved (35 +/- 14% to 53 +/- 18%) (P = .05) after abstention. Intensities of uptake HLR of > 1.87 were associated with increased risk of death or transplantation. CONCLUSIONS: In patients with IDC, variations of MAA uptake are detected in patients who present acutely but not in those with chronic stable disease. In patients with ADC, MAA uptake mainly depends on alcohol consumption. In both situations, reduction of uptake correlates with improvement of ventricular function. Higher intensities of MAA uptake are associated with a worse outcome. The intensity of antibody uptake, along with other clinical and functional variables, may be helpful in risk stratification of patients with dilated cardiomyopathy.

This article has been cited by other articles:

				H. N. Skouri, G. W. Dec, M. G. Friedrich, and L. T. Cooper Noninvasive Imaging in Myocarditis J. Am. Coll. Cardiol., November 21, 2006; 48(10): 2085 - 2093. [Abstract] [Full Text] [PDF]

				M. E. R. Martin, J. L. Moya-Mur, M. Casanova, A. Crespo-Diez, E. Asin-Cardiel, J. M. Castro-Beiras, L. Diez-Jimenez, M. Ballester, I. Carrio, and J. Narula Role of Noninvasive Antimyosin Imaging in Infants and Children with Clinically Suspected Myocarditis J. Nucl. Med., March 1, 2004; 45(3): 429 - 437. [Abstract] [Full Text]

				F. Zannad, S. Briancon, Y. Juilliere, P.-M. Mertes, J.-P. Villemot, F. Alla, J.-M. Virion, and and the EPICAL Investigators Incidence, clinical and etiologic features, and outcomes of advanced chronic heart failure: the EPICAL study J. Am. Coll. Cardiol., March 1, 1999; 33(3): 734 - 742. [Abstract] [Full Text] [PDF]

				V. Marti, M. Ballester, C. Udina, I. Carrio, E. Alvarez, D. Obrador, and G. Pons-Llado Evaluation of Myocardial Cell Damage by In-111-Monoclonal Antimyosin Antibodies in Patients Under Chronic Tricyclic Antidepressant Drug Treatment Circulation, March 15, 1995; 91(6): 1619 - 1623. [Abstract] [Full Text]