Abstract
This study examined the progression of left ventricular dysfunction and myocardial fibrosis in patients with Duchenne muscular dystrophy (DMD) or Becker muscular dystrophy (BMD) to evaluate the effects of angiotensin-converting enzyme inhibitor (ACEI). Ninety-eight cardiovascular magnetic resonance (CMR) studies in 34 consecutive patients with DMD (n = 21) or BMD (n = 13) were retrospectively reviewed. Left ventricular ejection fraction (LVEF) and the extent of myocardial late gadolinium enhancement (LGE) were semiautomatically quantified. During the study period, five patients had already been treated with ACEI at the first CMR; five were started on ACEI at LVEF ≥ 55% and 10 at LVEF < 55%. All patients had hyperenhanced myocardium on LGE images at the first CMR (median extent, 3.3%; interquartile range 0.1–14.3%). A mixed-effects model for longitudinal data of each patient, adjusted for age, type of muscular dystrophy, steroid use, and ACEI use showed that higher age (β = − 1.1%/year; 95% confidence interval [CI], − 1.8% to − 0.4%; p = 0.005) and no use of ACEI (β = − 3.1%; 95% CI, − 5.4% to − 0.8%; p = 0.009) were significantly associated with a lower LVEF. When ACEI use was stratified by time of initiation (LVEF ≥ 55% vs. < 55%), only ACEI initiation at LVEF < 55% had a beneficial effect on LVEF at each imaging examination (β = 3.7%; 95% CI, 0.9–6.4%; p = 0.010). ACEI use or the time of initiation of ACEI did not significantly affect age-related increase in LGE. ACEI attenuated the age-related decline in LVEF only in patients with DMD or BMD and reduced LVEF, suggesting that further investigation on prophylactic use of cardioprotective therapy in these patients is warranted.
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References
Eagle M, Baudouin SV, Chandler C, Giddings DR, Bullock R, Bushby K (2002) Survival in Duchenne muscular dystrophy: improvements in life expectancy since 1967 and the impact of home nocturnal ventilation. Neuromuscul Disord 12:926–929. https://doi.org/10.1016/S0960-8966(02)00140-2
Melacini P, Fanin M, Danieli GA, Villanova C, Martinello F, Miorin M, Freda MP, Miorelli M, Mostacciuolo ML, Fasoli G, Angelini C, Volta SD (1996) Myocardial involvement is very frequent among patients affected with subclinical Becker’s muscular dystrophy. Circulation 94:3168–3175. https://doi.org/10.1161/01.CIR.94.12.3168
Jefferies JL, Eidem BW, Belmont JW, Craigen WJ, Ware SM, Fernbach SD, Neish SR, Smith EO, Towbin JA (2005) Genetic predictors and remodeling of dilated cardiomyopathy in muscular dystrophy. Circulation 112:2799–2804. https://doi.org/10.1161/CIRCULATIONAHA.104.528281
Melacini P, Fanin M, Danieli GA, Fasoli G, Villanova C, Angelini C, Vitiello L, Miorelli M, Buja GF, Mostacciuolo ML, Pegoraro E, Volta SD (1993) Cardiac involvement in Becker muscular dystrophy. J Am Coll Cardiol 22:1927–1934. https://doi.org/10.1016/0735-1097(93)90781-U
Silva MC, Meira ZM, Gurgel Giannetti J, da Silva MM, Campos AF, Barbosa Mde M, Starling Filho GM, Ferreira Rde A, Zatz M, Rochitte CE (2007) Myocardial delayed enhancement by magnetic resonance imaging in patients with muscular dystrophy. J Am Coll Cardiol 49:1874–1879. https://doi.org/10.1016/j.jacc.2006.10.078
Tandon A, Villa CR, Hor KN, Jefferies JL, Gao Z, Towbin JA, Wong BL, Mazur W, Fleck RJ, Sticka JJ, Benson DW, Taylor MD (2015) Myocardial fibrosis burden predicts left ventricular ejection fraction and is associated with age and steroid treatment duration in duchenne muscular dystrophy. J Am Heart Assoc. https://doi.org/10.1161/JAHA.114.001338
Feingold B, Mahle WT, Auerbach S, Clemens P, Domenighetti AA, Jefferies JL, Judge DP, Lal AK, Markham LW, Parks WJ, Tsuda T, Wang PJ, Yoo SJ, American Heart Association Pediatric Heart Failure Committee of the Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; Council on Cardiovascular Radiology and Intervention; Council on Functional Genomics and Translational Biology; and Stroke Council (2017) Management of cardiac involvement associated with neuromuscular diseases: a scientific statement From the American Heart Association. Circulation 136:e200–e231. https://doi.org/10.1161/CIR.0000000000000526
Silva MC, Magalhaes TA, Meira ZM, Rassi CH, Andrade AC, Gutierrez PS, Azevedo CF, Gurgel-Giannetti J, Vainzof M, Zatz M, Kalil-Filho R, Rochitte CE (2017) Myocardial fibrosis progression in Duchenne and Becker muscular dystrophy: a randomized clinical trial. JAMA Cardiol 2:190–199. https://doi.org/10.1001/jamacardio.2016.4801
Duboc D, Meune C, Pierre B, Wahbi K, Eymard B, Toutain A, Berard C, Vaksmann G, Weber S, Becane HM (2007) Perindopril preventive treatment on mortality in Duchenne muscular dystrophy: 10 years’ follow-up. Am Heart J 154:596–602. https://doi.org/10.1016/j.ahj.2007.05.014
Aikawa T, Naya M, Obara M, Oyama-Manabe N, Manabe O, Magota K, Ito YM, Katoh C, Tamaki N (2017) Regional interaction between myocardial sympathetic denervation, contractile dysfunction, and fibrosis in heart failure with preserved ejection fraction: 11C-hydroxyephedrine PET study. Eur J Nucl Med Mol Imaging 44:1897–1905. https://doi.org/10.1007/s00259-017-3760-y
Aikawa T, Oyama-Manabe N, Naya M, Ohira H, Sugimoto A, Tsujino I, Obara M, Manabe O, Kudo K, Tsutsui H, Tamaki N (2017) Delayed contrast-enhanced computed tomography in patients with known or suspected cardiac sarcoidosis: a feasibility study. Eur Radiol 27:4054–4063. https://doi.org/10.1007/s00330-017-4824-x
Nassenstein K, Breuckmann F, Bucher C, Kaiser G, Konorza T, Schafer L, Konietzka I, de Greiff A, Heusch G, Erbel R, Barkhausen J (2008) How much myocardial damage is necessary to enable detection of focal late gadolinium enhancement at cardiac MR imaging? Radiology 249:829–835. https://doi.org/10.1148/radiol.2493080457
Allen HD, Flanigan KM, Thrush PT, Dvorchik I, Yin H, Canter C, Connolly AM, Parrish M, McDonald CM, Braunlin E, Colan SD, Day J, Darras B, Mendell JR (2013) A randomized, double-blind trial of lisinopril and losartan for the treatment of cardiomyopathy in duchenne muscular dystrophy. PLoS Curr. https://doi.org/10.1371/currents.md.2cc69a1dae4be7dfe2bcb420024ea865
Viollet L, Thrush PT, Flanigan KM, Mendell JR, Allen HD (2012) Effects of angiotensin-converting enzyme inhibitors and/or beta blockers on the cardiomyopathy in Duchenne muscular dystrophy. Am J Cardiol 110:98–102. https://doi.org/10.1016/j.amjcard.2012.02.064
Duboc D, Meune C, Lerebours G, Devaux JY, Vaksmann G, Becane HM (2005) Effect of perindopril on the onset and progression of left ventricular dysfunction in Duchenne muscular dystrophy. J Am Coll Cardiol 45:855–857. https://doi.org/10.1016/j.jacc.2004.09.078
Schram G, Fournier A, Leduc H, Dahdah N, Therien J, Vanasse M, Khairy P (2013) All-cause mortality and cardiovascular outcomes with prophylactic steroid therapy in Duchenne muscular dystrophy. J Am Coll Cardiol 61:948–954. https://doi.org/10.1016/j.jacc.2012.12.008
Lonn EM, Yusuf S, Jha P, Montague TJ, Teo KK, Benedict CR, Pitt B (1994) Emerging role of angiotensin-converting enzyme inhibitors in cardiac and vascular protection. Circulation 90:2056–2069. https://doi.org/10.1161/01.CIR.90.4.2056
Mewton N, Liu CY, Croisille P, Bluemke D, Lima JA (2011) Assessment of myocardial fibrosis with cardiovascular magnetic resonance. J Am Coll Cardiol 57:891–903. https://doi.org/10.1016/j.jacc.2010.11.013
Hor KN, Wansapura J, Markham LW, Mazur W, Cripe LH, Fleck R, Benson DW, Gottliebson WM (2009) Circumferential strain analysis identifies strata of cardiomyopathy in Duchenne muscular dystrophy: a cardiac magnetic resonance tagging study. J Am Coll Cardiol 53:1204–1210. https://doi.org/10.1016/j.jacc.2008.12.032
Soslow JH, Damon SM, Crum K, Lawson MA, Slaughter JC, Xu M, Arai AE, Sawyer DB, Parra DA, Damon BM, Markham LW (2016) Increased myocardial native T1 and extracellular volume in patients with Duchenne muscular dystrophy. J Cardiovasc Magn Reson 18:5. https://doi.org/10.1186/s12968-016-0224-7
Maisel AS, Bhalla V, Braunwald E (2006) Cardiac biomarkers: a contemporary status report. Nat Clin Pract Cardiovasc Med 3:24–34. https://doi.org/10.1038/ncpcardio0405
Price JF, Thomas AK, Grenier M, Eidem BW, O’Brian Smith E, Denfield SW, Towbin JA, Dreyer WJ (2006) B-type natriuretic peptide predicts adverse cardiovascular events in pediatric outpatients with chronic left ventricular systolic dysfunction. Circulation 114:1063–1069. https://doi.org/10.1161/circulationaha.105.608869
Cheeran D, Khan S, Khera R, Bhatt A, Garg S, Grodin JL, Morlend R, Araj FG, Amin AA, Thibodeau JT, Das S, Drazner MH, Mammen PPA (2017) Predictors of death in adults with Duchenne muscular dystrophy-associated cardiomyopathy. J Am Heart Assoc. https://doi.org/10.1161/jaha.117.006340
Raman SV, Hor KN, Mazur W, Halnon NJ, Kissel JT, He X, Tran T, Smart S, McCarthy B, Taylor MD, Jefferies JL, Rafael-Fortney JA, Lowe J, Roble SL, Cripe LH (2015) Eplerenone for early cardiomyopathy in Duchenne muscular dystrophy: a randomised, double-blind, placebo-controlled trial. Lancet Neurol 14:153–161. https://doi.org/10.1016/s1474-4422(14)70318-7
Acknowledgements
We thank Drs. Yukitoshi Isikawa and Yuka Ishikawa for providing DMD/BMD-specific knowledge and insight and Kinya Ishizaka for technical assistance.
Funding
This study was funded by the Miyata Cardiac Research Promotion Foundation (to Tadao Aikawa). The funder had no role in the study design, data collection, analysis, interpretation of data, or in the writing of the manuscript.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
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Aikawa, T., Takeda, A., Oyama-Manabe, N. et al. Progressive left ventricular dysfunction and myocardial fibrosis in Duchenne and Becker muscular dystrophy: a longitudinal cardiovascular magnetic resonance study. Pediatr Cardiol 40, 384–392 (2019). https://doi.org/10.1007/s00246-018-2046-x
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DOI: https://doi.org/10.1007/s00246-018-2046-x