| Prognostic value of pacing-induced mechanical alternans in patients with mild-to-moderate idiopathic dilated cardiomyopathy in sinus rhythm. | |
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MedLine Citation:
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PMID: 16580526 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: The relation between the occurrence of pacing-induced mechanical alternans and prognosis in patients with mild-to-moderate idiopathic dilated cardiomyopathy (IDCM) in sinus rhythm was investigated prospectively. The myocardial expression of genes for Ca2+-handling proteins in such patients was also examined. BACKGROUND: Mechanical alternans occurs in some patients with severe heart failure, but the relation between the occurrence of mechanical alternans and prognosis in patients with IDCM has remained unknown. METHODS: Left ventricular (LV) pressure was measured during atrial pacing, and LV endomyocardial biopsy specimens were collected in 36 IDCM patients and 8 controls. Idiopathic dilated cardiomyopathy patients were divided into two groups consisting of 22 individuals who did not develop mechanical alternans at heart rates up to 140 beats/min (group A) and of 14 individuals who did (group B). The patients were followed up for a mean of 3.7 years. RESULTS: There was no significant difference in LV ejection fraction or the plasma concentration of brain natriuretic peptide between groups A and B. The myocardial abundance of ryanodine receptor 2 messenger ribonucleic acid (mRNA) was significantly lower in groups A and B than in controls, whereas that of sarcoplasmic reticulum Ca2+-ATPase mRNA was significantly lower in group B than in group A or controls. Stepwise multivariate analysis identified pacing-induced mechanical alternans as the strongest predictor of cardiac events. Event-free survival in group A was significantly greater than that in group B. CONCLUSIONS: The occurrence of pacing-induced mechanical alternans is a potentially useful indicator of poor prognosis in patients with mild-to-moderate IDCM in sinus rhythm. |
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Authors:
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Akihiro Hirashiki; Hideo Izawa; Fuji Somura; Koji Obata; Tomoko Kato; Takao Nishizawa; Akira Yamada; Hiroyuki Asano; Satoru Ohshima; Akiko Noda; Shigeo Iino; Kohzo Nagata; Kenji Okumura; Toyoaki Murohara; Mitsuhiro Yokota |
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Publication Detail:
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Type: Journal Article Date: 2006-03-20 |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 47 ISSN: 1558-3597 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2006 Apr |
Date Detail:
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Created Date: 2006-04-03 Completed Date: 2006-05-26 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 1382-9 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiovascular Genome Science, Nagoya University School of Medicine, Nagoya, Japan. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Calcium-Transporting ATPases / genetics Cardiac Pacing, Artificial / adverse effects* Cardiomyopathy, Dilated / complications, metabolism, physiopathology*, therapy* Case-Control Studies Endocardium / metabolism Female Heart Conduction System / physiopathology* Heart Diseases / etiology Heart Rate* Humans Male Middle Aged Multivariate Analysis Myocardium / metabolism Prognosis Prospective Studies RNA, Messenger / metabolism Ryanodine Receptor Calcium Release Channel / genetics Sarcoplasmic Reticulum / enzymology Survival Analysis |
| Chemical | |
Reg. No./Substance:
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0/RNA, Messenger; 0/Ryanodine Receptor Calcium Release Channel; EC 3.6.1.8/Calcium-Transporting ATPases |
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