title: Histologic evidence of myocardial damage in apparently healthy subjects with ventricular arrhythmias and myocardial dysfunction.
abstract: The association of ventricular arrhythmias and myocardial dysfunction could be considered an early step toward cardiomyopathy; therefore, we studied 28 patients in NYHA class I and II, characterized by complex ventricular arrhythmias (VA) on 24-h Holter monitoring and volumetric and/or contractile abnormalities on a standard two-dimensional echocardiogram (2-D echo). All patients underwent radioisotopic angiography, 20 patients complete hemodynamic study, and 15 patients endomyocardial biopsy. Ambulatory ECG monitoring showed the presence of frequent premature ventricular contractions in 14 patients (50%) and episodes of ventricular tachycardia in 16 patients (57%). 2-D echo showed mono- or biventricular enlargement and dyssynergies in 25 patients (89%) (left ventricle in 6, right ventricle in 11, both in 8). Two patients showed only left ventricle enlargement and one patient isolated left ventricular dyssynergies. Radioisotopic angiography showed mono- or biventricular ejection fraction reduction in 24 patients (85%) and regional dyssynergies in 24 patients (85%) in accordance with 2-D echo. Hemodynamic study showed in all patients normal coronary arteries, and right and left angiography confirmed enlargement and/or regional dyssynergies. Endomyocardial biopsy was abnormal in 11 of 15 patients: various degrees of hypertrophy, parcellar fibrosis, and adipogenic infiltration were found. Our preliminary data suggest that the simultaneous occurrence of ventricular arrhythmias and ventricular dyssynergies and/or enlargement in patients without apparent clinical heart disease may represent an early stage of dilated cardiomyopathy.
authors.affiliation: C.N.R., Institute of Clinical Physiology, Pisa, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Contini
authors.forename: S
authors.initials: S
authors.lastname: Berti
authors.forename: D
authors.initials: D
authors.lastname: Levorato
authors.forename: M G
authors.initials: MG
authors.lastname: Bongiorni
authors.forename: M T
authors.initials: MT
authors.lastname: Baratto
authors.forename: C
authors.initials: C
authors.lastname: Arlotta
authors.forename: M
authors.initials: M
authors.lastname: Piacenti
authors.forename: A
authors.initials: A
authors.lastname: Pozzolini
authors.forename: L
authors.initials: L
authors.lastname: Paperini
authors.forename: G
authors.initials: G
authors.lastname: Kraft
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002311:Cardiomyopathy, Dilated / Q000473:pathology* / Q000503:physiopathology; D015150:Echocardiography, Doppler; D015716:Electrocardiography, Ambulatory; D005260:Female; D015637:Gated Blood-Pool Imaging; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D013610:Tachycardia / Q000473:pathology* / Q000503:physiopathology