The latest treatment for myocardial dilation in China

Modern China is developing rapidly, not just in the field of science and technology, but has also involved the development of talents in various fields. Medicine is developing even more rapidly. Many diseases that were previously incurable now have solutions, and some methods are even more advanced and effective than those abroad. For diseases like myocardial dilatation, what are the latest treatments in China? Today I will introduce to you the latest treatment for myocardial dilatation in China.

Dilated cardiomyopathy (DCM) is a heterogeneous cardiomyopathy and a common disease leading to heart failure (HF) and sudden death, which seriously endangers human health. The treatment of DCM is currently limited to the treatment of heart failure and arrhythmias. How to diagnose DCM early and identify the cause to improve clinical diagnosis level? How to effectively intervene in the pathogenesis and causes of DCM at an early stage and improve clinical treatment capabilities? The "Guidelines for the Diagnosis and Treatment of Dilated Cardiomyopathy in China" (hereinafter referred to as the "Guidelines"), written by the Chinese Medical Association's Cardiovascular Disease Branch and the Chinese Myocarditis Cardiomyopathy Collaborative Group, was published online on April 23, 2018. The Guidelines fully cited the clinical evidence of Chinese experts' research on DCM and brought some innovative ideas to the diagnosis and treatment of DCM.

Clarify the etiology of DCM and detect biomarkers

The guidelines divide DCM into primary and secondary types. Primary DCM includes familial DCM, acquired DCM and idiopathic DCM. Using anti-myocardial antibodies as immune markers, the immune type of DCM was proposed. Secondary DCM refers to systemic diseases involving the myocardium, and myocardial lesions are only part of the systemic disease.

The guideline advocates the etiological diagnosis of DCM and recommends biomarker testing. Genetic marker testing and immune marker anti-myocardial antibody testing are helpful for the etiological diagnosis of familial DCM and immune DCM. Medical history inquiry is helpful for the clinical diagnosis of alcoholic cardiomyopathy and peripartum cardiomyopathy.

In 1985, Schultheiss from Germany was the first to discover anti-mitochondrial adenine nucleoside isomerase antibodies in the serum of patients with idiopathic DCM. He then discovered autoantibodies to different myocardial target proteins and studied the pathogenic mechanism of antibodies. In 2011, Liao Yuhua et al. found that anti-L-type calcium channel antibodies (anti-L-CaC antibodies) in DCM patients can cause ventricular arrhythmias and sudden death, and clarified its mechanism of action.

In 2014, a clinical study by Pu Jielin et al. confirmed that after a 52-month follow-up, the incidence of total death, all-cause death and sudden death in the DCM group (n=732) and the control group (n=834) were significantly higher in the DCM patients with positive anti-L-CaC antibodies than in the control group; 2062 patients with chronic heart failure (CHF) and 824 control groups were followed up for 36 months. Among the 379 CHF patients who died, the sudden death rates in the DCM group and ischemic cardiomyopathy (ICM) group were 40.37% and 39.07%, respectively. The sudden death rates in patients with positive anti-β1AR antibodies in the DCM and ICM groups were significantly higher than those in the control group. A meta-analysis of DCM in China showed that anti-myocardial antibodies have high sensitivity and specificity for the early diagnosis of DCM. Several clinical observational studies in China have confirmed that positive anti-L-CaC antibodies and anti-β1AR antibodies have independent predictive value for CHF death and DCM sudden death.