Implantable Cardioverter-defibrillator for Primary Prevention of Sudden Cardiac Death in Non-ischemic Cardiomyopathy / 대한내과학회지

The insertion of implantable cardioverter-defibrillators (ICD) in patients with non-ischemic cardiomyopathy (NICM) has been recommended by recent guidelines. However, current evidence shows limited benefits to inserting ICDs in patients with NICM. Recently, the defibrillator implantation in patients with non-ischemic systolic heart failure (DANISH) trial, a large randomized trial of more than 1,100 patients with NICM, was conducted to compare the primary prevention of all-cause mortality between optimal medical therapy, cardiac resynchronization therapy, and ICD implantation. The DANISH trial revealed no differences in all-cause mortality between the groups after 5 years. However, in patients younger than 68 years of age, the rate of death from any cause was significantly lower in the ICD group compared to the control group. In addition, the rate of sudden cardiac death was lower in the ICD group compared to the control group in patients under 68 years. The results of DANISH will likely change guidelines about the insertion of ICD in patients with NICM, and encourage the use of ICD in patients with NICM.

Cardiac Magnetic Resonance Scar Imaging for Sudden Cardiac Death Risk Stratification in Patients with Non-Ischemic Cardiomyopathy

In patients with non-ischemic cardiomyopathy (NICM), risk stratification for sudden cardiac death (SCD) and selection of patients who would benefit from prophylactic implantable cardioverter-defibrillators remains challenging. We aim to discuss the evidence of cardiac magnetic resonance (CMR)-derived myocardial scar for the prediction of adverse cardiovascular outcomes in NICM. From the 15 studies analyzed, with a total of 2747 patients, the average prevalence of myocardial scar was 41%. In patients with myocardial scar, the risk for adverse cardiac events was more than 3-fold higher, and risk for arrhythmic events 5-fold higher, as compared to patients without scar. Based on the available observational, single center studies, CMR scar assessment may be a promising new tool for SCD risk stratification, which merits further investigation.

Non-mass-forming Lymphoma of the Left Ventricle Mimicking Non-ischemic Cardiomyopathy on MR Imaging: A Case Report

We report a case of cardiac lymphoma in a 40-year-old man, who had a mediastinal mass which was diagnosed as sclerosing mediastinitis pathologically. The mediastinal mass caused right pulmonary arterial stenosis. The patient developed myocardial hypertrophy and echocardiography showed restrictive physiology and severely decreased left ventricle ejection fraction, 6 months later. MRI showed global left ventricular myocardial hypertrophy and diffuse late gadolinium hyperenhancement after administration of contrast material. Thus, non-ischemic cardiomyopathy was suspected on MRI. However, pathology confirmed the myocardial abnormality as lymphoma after myocardial biopsy. Because a basal part of the left ventricle and global subendocardial myocardium were not involved on contrast-enhanced delayed MRI, the MRI abnormalities could be differentiated from amyloidosis and other myocardial diseases. The peculiar non-mass forming diffuse hypertrophy pattern of cardiac lymphoma has not been known in the MRI literature.

The Role of Carotid Atheroscleros is in the Distinction BetweenIs chemic and Non-is chemic Cardiomyopathy

BACKGROUNDS: Ischemic cardiomyopathy in the elderly bears a worse prognosis than non-ischemic cardiomyopathy, and may show an improved outcome after myocardial revascularization. The noninvasive techniques which can reliably distinquish between ischemic and non-ischemic cardiomyopathy have been tested. As ultrasonographically assessed carotid atherosclerosis is being used as a surrogate measure of coronary atherosclerosis, non studies to date have used carotid atherosclerosis to distinguish between ischemic and non-ischemic cardiomyopathy in the elderly. METHODS: One hundred forty eight patients(61 women, 87 male) greater than 65 years of age who have dilated cardiomyopathy with left ventricular enddiastolic inner dimension 55mm and fractional shortening 25% were evaluated by B-mode ultrasound imaging of carotid artery for measurement of atherosclerotic plaque. Also coronary angiography was done, and ischemic cardiomyo- pathy was defined as the presence of any 2 or more epicardial coronary vessels with 75% stenosis. and then the value of carotid athe rosclerosis in the distinction between ischemic and non-ischemic etiology in the elderly with dilated cardiomyopathy was examined. RESULTS: Ischemic etiology of dilated cardiomyopathy in the elderly can be defined as the presence of carotid atherosclerosis with 25% stenosis. Carotid stenosis 25% had sensitivity 82.5%(74% in women, 91% in male), specificity 85.5%(92% in women, 79% in male), positive predictive value 90.5%(93% in women, 88% in male) and negative predictive value 78.5%(73% in women, 84% in male) as whole in the identification of patients with ischemic cardiomyopathy. CONCLUSION: Carotid stenosis by B-mode ultrasonography is noninvasive and useful in the distinction between ischemic and nonischemic etiology in the elderly patients with clinically unexplained cardiomyopathy