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CLINICAL RESEARCH

Myocardial Delayed Enhancement by Magnetic Resonance Imaging in Patients With Muscular Dystrophy

Marly Conceição Silva, MD^_*, Zilda Maria Alves Meira, MD, PhD, Juliana Gurgel Giannetti, MD, PhD, Marcelo Moreira da Silva, Alysson Félix Oliveira Campos, RT^_*, Márcia de Melo Barbosa, MD, PhD^_*, Geraldo Moll Starling Filho, MD^_*, Rogério de Aguiar Ferreira, MD^_*, Mayana Zatz, PhD and Carlos Eduardo Rochitte, MD, PhD^_*,,_*

^_* Axial Centro de Imagem, Belo Horizonte
Federal University of Minas Gerais Medical School, Minas Gerais, Brazil
Human Genome Research Center, Biosciences Institute, University of São Paulo
Heart Institute (InCor) University of São Paulo Medical School, São Paulo, Brazil

Manuscript received May 22, 2006; revised manuscript received September 21, 2006, accepted October 16, 2006.

^_* Reprint requests and correspondence: Dr. Carlos E. Rochitte, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Setor de Ressonância Magnética e Tomografia Cardiovascular, Avenida Dr. Enéas de Carvalho Aguiar, 44, Andar AB, Cerqueira César, São Paulo, SP, Brazil 05403-000. (Email: rochitte{at}incor.usp).

Objectives: This study sought to analyze whether cardiovascular magnetic resonance (CMR) can detect and quantify myocardial damage in the early stages of cardiomyopathy in muscular dystrophies (MD).

Background: Muscular dystrophy is a genetic disease that involves skeletal and cardiac tissues of humans. Cardiomyopathy is common, and death secondary to cardiac or respiratory diseases occurs early in life. Cardiovascular magnetic resonance is a reliable method for assessing global and regional cardiac function, allowing also for the detection of myocardial fibrosis (MF).

Methods: Ten patients with Duchenne or Becker dystrophies were studied by CMR. Physical examination, Chagas disease serological tests, electrocardiogram, chest radiograph, total creatine kinase, and Doppler echocardiogram were also obtained in all patients.

Results: Patients with MF had a lower ejection fraction than those without. Myocardial fibrosis (midwall and/or subepicardial) was observed in 7 of the 10 patients, and the lateral wall was the most commonly involved segment. There was moderate correlation between segmental MF and dysfunction.

Conclusions: Cardiovascular magnetic resonance can identify MF and may be useful for detecting the early stages of cardiomyopathy in MD. Future work will be needed to evaluate whether CMR can influence cardiomyopathy and outcomes.

Abbreviations and Acronyms   CK = creatine kinase   CMR = cardiovascular magnetic resonance   LV = left ventricle/ventricular   LVEF = left ventricular ejection fraction   MD = muscular dystrophy   MDE = myocardial delayed enhancement   MF = myocardial fibrosis   RV = right ventricle/ventricular

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