Investigations of patients with abnormal heart biomarkers and no history of heart disease or pulmonary arterial hypertension.
| Age/sex | Biomarkers | ECG | TTE | cMRI | Outcome |
|---|---|---|---|---|---|
| 74/F | cTnI, BNP, CPK | RBBB, LAFB, LQT | LVH, RVH, LA, RA, IVSH, DD, LVEF = 30% | LVH, RVH, LA, RA, IVSH | Heart biopsy was pathognomonic for AMIC. AM discontinuation led to steady decrease of both cTnI and BNP and regression of hypertrophy. |
| 63/F | cTnI, BNP, CPK | RBBB, LAFB | LVH, RVH, LA, IVSH, DD | LVH, RVH, LA, IVSH, LGE nonvascular | Heart biopsy was pathognomonic for AMIC. AM discontinuation led to steady decrease of both cTnI and BNP and regression of hypertrophy. |
| 74/F | cTnI, BNP, CPK | First-degree AVB | LVH, LA, IVSH, DD | LVH, RVH, LA, RA, IVSH | Normal coronary angiography. Patient succumbed from refractory heart failure, complicated with septic shock. Possible AMIC. |
| 59/F | cTnI, BNP | Normal | LVH, IVSH, LA, RA, DD | LVH, IVSH | Regression of hypertrophy and decrease of heart biomarkers after 6 months. Possible AMIC. |
| 49/F | cTnI, BNP, CPK | RBBB | LVH, RVH, IVSH, LA, DD | LVH, RVH, IVSH, LA | Regression of hypertrophy, all biomarkers normalized after 12 months. Possible AMIC. |
| 67/F | cTnI, BNP, CPK | Atrial fibrillation | LVH, LA, IVSH, DD | LVH, IVSH, LA | Possible AMIC, biomarkers at the same levels after 3 and 6 mos (AM not discontinued until later). |
| 49/M | cTnI, BNP | Normal | LVH, LA, IVSH, DD | ND | Coronary artery disease (2 vessels), biomarkers unchanged after 6 mos (AM not discontinued). |
| 57/F | cTnI, BNP, CPK | Nonspecific T abnormality | LVH, IVSH, regional hypokinesis, LVEF = 55% | LVH, LGE nonvascular, edema | Myocarditis. Treatment with cyclophosphamide and glucocorticoids led to regression of edema in cMRI. Partial decrease of biomarkers. |
| 30/F | BNP | Normal, right axis deviation | RVH, RVSP = 69 mmHg | ND | PH. Treatment with phosphodiesterase-5 inhibitors led to normalization of BNP after 6 mos. |
| 38/F | BNP | Normal | Small pericardial effusion, RVSP = 44 mmHg | ND | Patient had nephrotic syndrome owing to active lupus nephritis. Elevated BNP was attributed to volume overload. |
| 71/F | BNP | Possible LVH, incomplete RBBB | LVH | LVH | Uncontrolled hypertension. BNP remained at the same levels despite intensive treatment after 6 and 12 mos. Cardiac troponin was marginal and remained unchanged at the same time. |
| 71/F | BNP | Atrial fibrillation, Possible LA enlargement | LA enlargement, moderate MV regurgitation | LA, LVH | No specific cause identified. BNP remained at the same levels after 6 months. AM dose was decreased. |
| 44/F | BNP, CPK | Possible biatrial enlargement | Mild global hypokinesis of the LV, LVEF = 45% | ND | No specific cause identified. Coronary CT with Agatston score 0. BNP remained in the same levels after 6 and 12 mos. |
| 52/F | BNP | Normal | Normal | Normal | No specific cause identified. BNP remained in the same levels after 6 and 12 mos. |
| 64/F | BNP, CPK | RBBB, possible LVH | Normal | ND | No specific cause identified. BNP remained in the same levels after 3, 6, and 12 mos. |
| 48/M | cTnI, BNP | Nonspecific T abnormality | Normal | ND | No specific cause identified. BNP and cTnI were slightly decreased (still abnormal) after 6, 9, and 12 mos |
ECG: electrocardiogram; TTE: transthoracic echocardiogram; cMRI: cardiac magnetic resonance imaging; cTnI: cardiac troponin I; BNP: brain natriuretic peptide; CPK: creatine phosphokinase; RBBB: right bundle branch block; LAFB: left anterior fascicular block; LQT: long QT; LVH: left ventricular hypertrophy; RVH: right ventricular hypertrophy; LA: left atrium dilatation; RA: right atrium dilatation; IVSH: interventricular septum hypertrophy; LVEF: left ventricular ejection fraction; AM: antimalarials; AMIC: AM-induced cardiomyopathy; DD: diastolic dysfunction; LGE: late gadolinium enhancement; AVB: atrioventricular block; ND: not done; PH: pulmonary hypertension; RVSP: right ventricular systolic pressure; CT: computed tomography.