Congestive Heart FailureEvidence of cardiac myolysis in severe nonischemic heart failure and the potential role of increased wall strain*,**
Section snippets
Patients
We included patients with acute or stable chronic congestive HF at admission to our cardiology intensive care unit or during programed 1-day hospitalization. Patients with angina pectoris; recent or acute Q- or non-Q-wave myocardial infarction; severe pulmonary, renal, or hepatic disease; or a history of surgery within 30 days of inclusion were not eligible. To exclude all cases of coronary artery disease, patients were enrolled only when a coronary angiogram showed no atherosclerotic
Patients
Among the 71 patients, 35 patients with stable congestive HF were studied while ambulatory during programmed 1-day hospitalization, whereas the other 36 patients were studied at admission for acute congestive HF. Among the 35 patients with stable HF, 3 were in NYHA class IV, 6 in class III, and 24 in class II. Among the 36 patients with acute HF, 28 were admitted because of pulmonary edema, 2 died, 4 required mechanical ventilation, and 9 required inotropic drugs during their in-hospital stay
Discussion
This study shows (1) evidence of cardiac myolysis during severe HF in patients without coronary artery disease and (2) a correlation between cardiac myolysis, LV concentric remodeling, and a marker of LV chamber strain (BNP).
The transition from compensated to decompensated LV dysfunction is a major pathogenic and clinical event during the course of HF. Progressive cardiac myocyte loss seems to be associated with LV chamber dysfunction. The mechanisms of myocyte loss include necrosis and
Acknowledgements
We thank David Young for his help in the preparation of this manuscript.
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Supported by a grant from the French Federation of Cardiology. Cardiac Tnlus and BNP assays were gifts from Sanofi-Diagnostics-Pasteur, Marne-la-Coquette, France, and Cisbio International, Gif-Sur-Yvette, France.
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Reprint requests: Damien Logeart, MD, Service de Cardiologie, Hôpital Beaujon, 100 Bd Gal Leclerc, 92110 Clichy, France. E-mail: [email protected]