Ammons, Susan B.

Collins, Joseph F.

Egher, Cheryl

Gottdiener, John S.

Horney, R.N.

Krol, William F.

Massie, Barry

Petillo, Florentino

Elsevier - Publisher Connector 

Prevalence of left ventricular thrombus in dilated cardiomyopathy: The WATCH trial 

844-4 Prevalence of Left Ventricular Thrombus in Dilated 
Cardiomyopathy: The WATCH Trial 
John S. Gondiener, Barry Massie, Susan B. Ammons, Cheryl Egher, Florentine Petillo, 
William F. Krol. Ft. N. Homev. Joseoh F. Collins. St. Francis Hosoital. Roslvn. NY. VA 
Medical Cente;, San Fran&o, CA 
I 
The prevalence of left ventricular thrombus in patients with dilated cardiomyopathy has 
been estimated at 29-36% in relatively small studies, and is thought to contribute to sys- 
temic embolization. Methods We evaluated the prevalence of LV thrombus on 2D 
echocardiography in the WATCH trial, a multicenter prospective clinical trial of warfarin 
and antiplatelet agents in dilated cardiomyopathy. Ethos were performed prospectively 
in 1343 patients with NYHA class II-IV CHF and EF<35% who were in sinus rhythm (age 
63 * 11 years, EF 29 f 6%, LV end-diastolic volume 194 271 ml). Patients with recent (~3 
mos) myocardial infarction were excluded. Results: LV apical mural thrombus was noted 
in 26 patients (2.1%), and rated as probable or definite in 22, and suspected in 6. The 
presence of LV thrombus was associated with younger age (59 * 10 vs 62 * 11 years, 
p=. 029), lower EF (24 * 6 vs 29 t 6%, p=, 001). higher regional wall motion score (2.2 + 
.33 YS 1 .Ql f .39, p = .OOOOl) higher velocity of early diastolic filling (65 + 22 vs 77 * 26 
cmlsec, p=. OOOl), longer deceleration time (272 f 156 msec vs 235 * 116 msec. p -z 
.OOOl). greater left ventricular diastolic dimension (6.9 t .Q vs 6.3 * .6 cm, p = .05), and 
greater left atrial area (26 + 7 vs 21 f 6 cm2, p< .OOOOl). The presence of LV thrombus 
was not related to race, gender, the duration of CHF, prior myocardial infarction, coro- 
nary revascularization, or angina, diastolic function pattern, or RV systolic pressure. 
Conclusions: The prevalence of left ventricular thrombus in chronic dilated cardiomyop- 
athy is lower than that previously reported, possibly due to case selection and to 
improved echocardiographic techniques which lessen near-field artifact. However, the 
presence of left ventricular thrombus is associated with greater LV cavity size, as well as 
worse parameters of systolic and diastolic LV function. 
202A ABSTRACTS - Cardiac Function and Heart Failure 
patients, and calvedilol can modulate circulating MMP activity as well as TNF-alpha 
activity. The inhibition of TNF-alpha activity may directly influence cardiac matrix remod- 
eling in IDC. 
11:OOa.m. 
844-3 In Vivo Pressure-Volume Analysis of the Cardiac 
Effects of Chronic Cocaine in Mice 
Michael A. Mathier. Jennifer Dawson, Ravi Ramani, Richard P. Shannon, University of 
Pinsburgh, Pittsburgh, PA, Allegheny General Hospital, Pittsburgh, PA 
Background: The relationship between chronic cocaine use and cardiac dysfunction is 
unclear. Methods: TO explore this relationship, mice (C57BU6) were administered 
cocaine hydrochloride (30 “g/kg in 0.3~: normal saline) intraperitoneally (COC. n=15) or 
a similar volume of normal saline (SAL, n=15) daily for 90 days. At the completion of the 
protocol, suwivors were instrumented with a 1.4Fr Millar conductance catheter advanced 
retrograde into the left ventricle via the right carotid artery. Pressure-volume loops were 
recorded before and after transient inferior vena caval occlusion at baseline and during 
IV infusion of dobutamine (5 uglkglmin). Results: Survival (73% vs. 66%) was similar in 
the 2 groups. Len ventricular end-diastolic and end-systolic pressures tended to be 
higher in COC (12+/-4 and 66+/-Q mmtig, respectively) than in SAL (9+/-l and 60+/-6 
mmHg, respectively; p=O.l for both). Other hemodynamic data are summarized in the 
table. Ex viva LV mass (92+/-15 vs. 90+/-6 mg) was similar in the 2 groups. Conclusions: 
Chronic cocaine administration in mice results in LV dilation, systolic and diastolic dys- 
function, and impaired B-adrenergic responsiveness. This may serve as a valuable 
model for the study of cocaine-associated cardiomyopathy. 
Baseline Dobutamine 
HR 
(bpm) 
SA 567+/- 
L 55 
(Il= 
6) 
co 507+/- 
C 40’ 
(n= 
6) 
EDV EF dP/dtl Tau Ees EF dP/dVP Ees 
(ul) (%) P (msec) (mmHg (%) @c-l) (mmHg/ 
(sec- /ul) ul) 
1) 
l&2+/- 79+/- 104+/- 5.9+/- 3.3+l- go+/-2 177+/- 1 O.Q+l- 
3.1 6 13 0.4 0.9 # 15# 5.1 # 
22.4+/- 66+/- Ql+/-5 7.5+/- 2:6+/- 61+/-l 146+/- 4.2+/-l .6 
1.2’ 4’ * 1.3’ 0.7 ‘# 26’# * 
*, ~~0.05 vs. SAL; #, ~~0.05 vs. baseline. EDV, LV end-diastolic volume; Ees, end- 
systolic elastance. Values are mean +I- SD. 
11:15a.m. 
JACC March 19,2003 
11:30 a.m. 
844-5 Correlation of Increased Release of Cardiac MMP-1 in 
Patients With Dilated Cardiomyopathy With Left 
Ventricular-Diameter 
Michael Fassbach, Frauke Picard, Bodo E. Strauer, Bodo Schwanzkopfl, Heinrich- 
Heine-University Duesseldorf, Duesseldorf, Germany 
Background: Interstitial collagen is essential for left ventricular integrity. It has been 
reported that matrix-metalloproteinases (MMPs) are altered in hearts with dilated cardi- 
omyopathy (DCM). The aim of this study was to test circulating peripheral venous, coro- 
nary vents and amtic serum markers of collagen metabolism in DCM. Methods and 
Results: Patients with DCM (n=lQ; age 44*4 yrs., NYHA class > II, EF c45%, LVEDD 
>2.9cm/m2) and control subjects with normal LV size and exclusion of myocarditis or cm- 
onary artery disease (n=16; age 47*4 yrs.; NYHA class I-III, EF >45%, LVEDD <2.9cm/ 
“2) were investigated. Aortic, periperhal and coronary venous levels of matnx-metallo- 
proteinase-1 (MMP-l), its inhibitor, tissue inhibitor of metalloproteinase (TIMP-1), were 
measured using enzyme-linked immunoabsorbent assays. Serum concentrations (aortic, 
periperhal and coronary venous) of type I collagen carboxyterminal telopeptide (ICTP; 
marker of collagen degradation) and the carboxyterminal propeptide of type I procollagen 
(PICP; marker of collagen synthesis) were determined by radioimmunoassay. Peripheral 
venous MMP-1 and ICTP serum concentrations were significantly increased in the DCM 
group (5.03kO.79 ng/ml vs. 2.49i0.95 ng/ml; p=O.O2 and 6.05i1.50 ngiml vs. 4.02iO.71 
ng/ml; p< 0.001) as well as the free TIMP-1 concentration (210.59+18.61 ng/ml vs. 
137.54e12.76 ng/ml; p= 0.005). PICP was slightly increased in DCM. The coronary 
venous-am-tic difference (coronary sinus minus aorta) of the MMP-1 level was greater in 
the DCM group (1.56i0.49 vs. -0.59kO.24 ng/ml; p<O.OOl). The difference correlated 
with the coronary venous-aortic difference of ICTP (r=0.532; p=O.O4). The ICTP- and 
MMP-difference showed a correlation with LVEDD (w0.647; p=O.O09 and r&526; 
p=O.O4, respectively). Conclusion: These findlngs reveal an increased release of myo- 
cardial MMP-1 in DCM. Type I collagen degradation IS augmented in DCM. Thus, the 
increased release of myocardial MMP-1 could be a valuable marker for collagen degra- 
dation and LV dilation in DCM. 
11:45 a.m. 
844-6 A Common Mitochondrial DNA Variant Associated With 
Left Ventricular Hypertrophy in Type 2 Diabetes Mellitus 
Yukihiko Momivama, Michiko Furutani, Yoshihiko Suzuki, Shin-ichirou Imamura, 
Kazuhiro Hosokawa, Yoshihito Atsumi, Kempei Matsuoka. Mitsuru Kimura, Fumitaka 
Ohsuzu, Rumiko Matsuoka, National Defense Medical College, Saitama. Japan, Tokyo 
Women’s Medical University, Tokyo, Japan 
Background: DM was reported to be associated with a mitochondrial (mt) DNA mutation 
at 3243 and variants at 1310,1436,3290,3316,3394,12026,15927 and 16189. Among 
these mtDNA abnormalities, those at 3243, 3316, 15927 and 16169 were also reported 
to cause cardiomyopathy. LV hypenrophy (LVH) is common in DM. Some mtDNA abnor- 
malities may play a role in the development of LVH in DM. 
Methods: We performed genetic analysis in 33 DM patients (pts) with echocardiographic 
LVH (wall thickness z-12 mm), 79 DM pts without LVH and 100 non-DM controls. After 
DNA was extracted from blood, a heteroplasmic mutation at 3243 was examined by 
RFLP analysis using electrophoresis on polyacrylamide gel after Apal digestion. The 6 
mtDNA genes (tRNA LEU, tRNATHR, 12SrRNA, ND-l. ND-4 and Control), in which the 6 
homoplasmic variants described above are present, were analyzed by DNA sequencing. 
Results: DM pts with LVH were more hypertensive and obese than those without LVH. 
Among the repolted mtDNA variants, higher prevalence of the 16169 variant was found 
in DM pts with LVH YS those without LVH and controls (55% YS 23% and 22%, PcO.005) 
(Table). DNA sequencing also showed that variants at 709 and 16217 were mire com- 
mon in DM pts with LVH than those wthout LVH (36% and 21% vs 15% and 5%, 
PeO.025). However, multivariate analysis revealed that the 16169 variant was an Inde- 
pendent factor for LVH (OR=5.6, 95%CI 2.0-15.4, P<O.O02), but variants at 709 or 16217 
were not. 
Conclusion: A common mtDNA variant at 16169 was found to be associated with LVH 
in DM pts. 
Prevalence of mtDNA Variants m the 3 Groups 
mtDNA variants 1310 1436 3290 3394 1202 1592 16189 
6 7 
DM pts with LVH 0 1 0 0 1 1 18 
@=33) (0%) (3%) (0%) (0%) (3%) (3%) (55%) 
DM pts without LVH 0 0 I 5 l(1 0 
(n=79) (0%) (0%) (1%) (6%) %) (0%) 2283%) 
Non-DM controls 1 3 22 
(n=lOo) b%) 21%) k%) (1%) (3%) Y30%) (22%) 
‘P<O.W5 va DA4 without LVH and 
conwols. 
No pt had 3243 mutation or 3316 
variant 


file:///data/remote/core/dit/data/elsevier/pdf/ba7/aHR0cDovL2FwaS5lbHNldmllci5jb20vY29udGVudC9hcnRpY2xlL3BpaS9zMDczNTEwOTcwMzgxOTY2Ng==.pdf

Prevalence of left ventricular thrombus in dilated cardiomyopathy: The WATCH trial

Abstract

Similar works

Full text

Available Versions

Elsevier - Publisher Connector

Elsevier - Publisher Connector