Sorting out cardiomyopathies

[JAMESFETT]

Recent reports support certain tests for the diagnosis of cardiomyopathies:

1)Non invasive (for everyone):
a)Plasma biomarkers, such as CRP and Troponin
b)Cardiac Magnetic Resonance imaging with enhancement

2)Invasive (for those not improving to EF 40 % in first 2 to 4 months):
a)Endomyocardial biopsy
b)Immunohistochemistry on biopsy tissue
c)Polymerase chain reaction testing for virus on biopsy tissue

[see Schulz-Menger and associates: Integrated biomarkers in cardiomyopathies--a stepwise approach for diagnosis and treatment. Herz 2007;32:458-72.]

There is convincing evidence that supports current use of these diagnostic techniques for all new pregnancy-associated heart failure patients and new dilated cardiomyopathy patients.

AND:

"Pimobendan, FTY720 are promising agents for the treatment of viral myocarditis" [see Matsumori. Herz 2007;32:452-56.]

These newer treatments are still in research mode, but we are seeing progress.

JD

[reezlemom]

With cardiomyopathy, is there usually a Troponin elevation or is that a "possible" marker?

[JAMESFETT]

Early in the process there is often an elevation of the plasma cardiac troponin (T and/or I) level ; a recent study in China of 100 PPCM patients found elevated plasma cardiac troponin to be an indicator of worse prognosis for recovery, but there were lots of false negatives, meaning those who did not experience a rise and/or who despite higher levels went on to full recovery.

JD

[julianameng]

With cardiomyopathy, is there usually a Troponin elevation or is that a "possible" marker?
did you have an elevated troponin I or T.
My Troponin level is still elevated even though my EF is normal...so strange
Dr. Fett do you think my present troponin leak is an indicator for relapse with this pregnancy?

[JAMESFETT]

Probably not, UNLESS the value is rising. A better indicator, because less transient, would be plasma CRP (looking for values that are rising in excess of 10 mg/liter). Have you had that done?

JD

[julianameng]

yes last month so far so good. I just wish i could figure out this troponin mystery. I am so thankful that all is well so far.

[JAMESFETT]

Good! So far so good. That's one trimester done. In the second or third trimesters, IF any rise in BNP above the cut-off value, or elevation of plasma CRP over 10 mg/liter, or significant rise in plasma cardiac troponin you may want to consider with your cardiologist starting metoprolol or carvedilol.

JD