Progressive myocardial injury in myotonic dystrophy type II and facioscapulohumeral muscular dystrophy 1: a cardiovascular magnetic resonance follow-up study

Journal of Cardiovascular Magnetic Resonance

Luisa Schmacht¹  Jeanette Schulz-Menger²  Edyta Blaszczyk²  Carolin Lim²  Jan Gröschel²  Simone Spuler³  Peter Kellman⁴ 

[1] Department of Cardiology and Nephrology, Working Group Onn Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center a Joint Cooperation Between the Charité – Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Lindenberger Weg 80, 13125, Berlin, Germany;Department of Cardiology and Nephrology, Working Group Onn Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center a Joint Cooperation Between the Charité – Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Lindenberger Weg 80, 13125, Berlin, Germany;DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany;Muscle Research Unit, Experimental and Clinical Research Center a Jointoint Cooperationoperation Betweenetween the Charité Medical, Berlin, Germany;National Heart, Lung and Blood Institute, National Institute of Health, Bethesda, USA;

关键词: Magnetic Resonance Imaging;    Facioscapulohumeral muscular dystrophy type 1;    Myotonic dystrophy type 2;    Fat;    Fibrosis;    Remodeling;   

DOI  :  10.1186/s12968-021-00812-6

来源: Springer

【 摘 要 】

AimMuscular dystrophy (MD) is a progressive disease with predominantly muscular symptoms. Myotonic dystrophy type II (MD2) and facioscapulohumeral muscular dystrophy type 1 (FSHD1) are gaining an increasing awareness, but data on cardiac involvement are conflicting. The aim of this study was to determine a progression of cardiac remodeling in both entities by applying cardiovascular magnetic resonance (CMR) and evaluate its potential relation to arrhythmias as well as to conduction abnormalities.Methods and results83 MD2 and FSHD1 patients were followed. The participation was 87% in MD2 and 80% in FSHD1. 1.5 T CMR was performed to assess functional parameters as well as myocardial tissue characterization applying T1 and T2 mapping, fat/water-separated imaging and late gadolinium enhancement. Focal fibrosis was detected in 23% of MD2) and 33% of FSHD1 subjects and fat infiltration in 32% of MD2 and 28% of FSHD1 subjects, respectively. The incidence of all focal findings was higher at follow-up. T2 decreased, whereas native T1 remained stable. Global extracellular volume fraction (ECV) decreased similarly to the fibrosis volume while the total cell volume remained unchanged. All patients with focal fibrosis showed a significant increase in left ventricular (LV) and right ventricular (RV) volumes. An increase of arrhythmic events was observed. All patients with ventricular arrhythmias had focal myocardial changes and an increased volume of both ventricles (LV end-diastolic volume (EDV) p = 0.003, RVEDV p = 0.031). Patients with supraventricular tachycardias had a significantly higher left atrial volume (p = 0.047).ConclusionWe observed a remarkably fast and progressive decline of cardiac morphology and function as well as a progression of rhythm disturbances, even in asymptomatic patients with a potential association between an increase in arrhythmias and progression of myocardial tissue damage, such as focal fibrosis and fat infiltration, exists. These results suggest that MD2 and FSHD1 patients should be carefully followed-up to identify early development of remodeling and potential risks for the development of further cardiac events even in the absence of symptoms.Trial registration ISRCTN, ID ISRCTN16491505. Registered 29 November 2017 – Retrospectively registered, http://www.isrctn.com/ISRCTN16491505

【 授权许可】

CC BY