Midwall Fibrosis: Cardiac Magnetic Resonance Imaging in Risk Stratifying Cardiomyopathies

The United Kingdom’s National Institute for Health and Care Excellence guidance on implantable cardiac defibrillator (ICD) therapy recommend ICD in those with left ventricular dysfunction and a high risk of sudden cardiac death (SCD). SCD accounts for 30% deaths in non-ischaemic dilated cardiomyopathy (DCM), however risk stratifying and predicting SCD in DCM is a major management challenge. We present two cases demonstrating the potential role of cardiac magnetic resonance imaging in risk stratifying DCM

Chemerin is associated with markers of inflammation and components of the metabolic syndrome but does not predict coronary atherosclerosis.

Objectives: Chemerin is a recently discovered adipokine that regulates adipocyte differentiation and modulates chemotaxis and activation of dendritic cells and macrophages. Given the convergence of adipocyte and macrophage function, chemerin may provide an interesting link between obesity, inflammation and atherosclerosis in humans. We sought to examine the relationship of 1) chemerin and markers of inflammation, 2) chemerin and components of the metabolic syndrome, and 3) chemerin and coronary atherosclerotic plaque burden and morphology. Design: Serum chemerin levels were determined in 303 patients with stable typical or atypical chest pain who underwent dual-source multi-slice CT-angiography to exclude coronary artery stenosis. Atherosclerotic plaques were classified as calcified, mixed or non-calcified. Results: Chemerin levels were highly correlated with hsCRP (r=0.44, p<0.0001), IL-6 (r=0.18, p=0.002), TNF-{alpha} (r=0.24, p<0.0001), resistin (r=0.28, p<0.0001) and leptin (r=0.36, p<0.0001) concentrations. Furthermore, chemerin was associated with components of the metabolic syndrome including BMI (r=0.23, p=0.0002), triglycerides (r=0.29, p<0.0001), HDL-C (r=-0.18, p=0.003) and hypertension (p<0.0001). In bivariate analysis, chemerin levels weakly correlated with coronary plaque burden (r=0.16, p=0.006) and the number of non-calcified plaques (r=0.14, p=0.02). These associations, however, were lost after adjusting for established cardiovascular risk factors (OR 1.17, 95%CI 0.97 to 1.41, p=0.11 for coronary plaque burden; OR 1.06, 95%CI 0.96 to 1.17, p=0.22 for non-calcified plaques). Conclusions: Chemerin is strongly associated with markers of inflammation and components of the metabolic syndrome. Chemerin, however, does not predict coronary atherosclerosis