Miocardiopatía dilatada: causas, diagnóstico y manejo actual - Revisión de la Literatura
DOI:
https://doi.org/10.56183/iberojhr.v5i1.721Palavras-chave:
Miocardiopatía dilatada, Insuficiencia cardíaca, Diagnóstico, Tratamiento, Etiología, Manejo actual.Resumo
La miocardiopatía dilatada (MCD) es una enfermedad cardíaca caracterizada por la dilatación y disfunción sistólica del ventrículo izquierdo, que puede afectar también al ventrículo derecho y conducir a insuficiencia cardíaca progresiva. Este artículo de revisión narrativa aborda las principales causas de la MCD, que incluyen factores genéticos, infecciones virales, enfermedades autoinmunes, tóxicos y trastornos metabólicos, entre otros. Asimismo, se analizan los avances en el diagnóstico, destacando el papel de técnicas como la resonancia magnética cardíaca y los estudios genéticos, que han permitido una mejor caracterización de la enfermedad. En cuanto al manejo, se revisan enfoques terapéuticos actuales que abarcan desde el tratamiento farmacológico estándar con inhibidores de la ECA, bloqueadores beta y antagonistas de los receptores de aldosterona, hasta intervenciones avanzadas como dispositivos de asistencia ventricular y trasplante cardíaco en casos refractarios. Finalmente, se subraya la importancia de un enfoque multidisciplinario para optimizar el pronóstico y mejorar la calidad de vida de los pacientes con esta compleja patología.
Referências
Schultheiss HP, Fairweather D, Caforio ALP, Escher F, Hershberger RE, Lipshultz SE, Liu PP, Matsumori A, Mazzanti A, McMurray J, Priori SG. Dilated cardiomyopathy. Nat Rev Dis Primers. 2019 May 9;5(1):32. doi: 10.1038/s41572-019-0084-1.
Weintraub RG, Semsarian C, Macdonald P. Dilated cardiomyopathy. Lancet. 2017 Jul 22;390(10092):400-414. doi: 10.1016/S0140-6736(16)31713-5.
McKenna WJ, Maron BJ, Thiene G. Classification, Epidemiology, and Global Burden of Cardiomyopathies. Circ Res. 2017 Sep 15;121(7):722-730. doi: 10.1161/CIRCRESAHA.117.309711.
McKenna WJ, Judge DP. Epidemiology of the inherited cardiomyopathies. Nat Rev Cardiol. 2021 Jan;18(1):22-36. doi: 10.1038/s41569-020-0428-2.
Myers MC, Breznen B, Zhong Y, Maruyama S, Bueno C, Bastien A, Fazeli MS, Golchin N. Diverse Concepts in Definitions of Dilated Cardiomyopathy: Theory and Practice. Cardiol Res. 2024 Oct;15(5):319-329. doi: 10.14740/cr1679.
Owen R, Buchan R, Frenneaux M, Jarman JWE, Baruah R, Lota AS, et al. Sex Differences in the Clinical Presentation and Natural History of Dilated Cardiomyopathy. JACC Heart Fail. 2024 Feb;12(2):352-363. doi: 10.1016/j.jchf.2023.10.009.
Jain A, Norton N, Bruno KA, Cooper LT Jr, Atwal PS, Fairweather D. Sex Differences, Genetic and Environmental Influences on Dilated Cardiomyopathy. J Clin Med. 2021 May 25;10(11):2289. doi: 10.3390/jcm10112289.
Gentile P, Merlo M, Cannatà A, Gobbo M, Artico J, Stolfo D, et al. Dilated Cardiomyopathy With Mid-Range Ejection Fraction at Diagnosis: Characterization and Natural History. J Am Heart Assoc. 2019 Sep 3;8(17):e010705. doi: 10.1161/JAHA.118.010705.
Heymans S, Lakdawala NK, Tschöpe C, Klingel K. Dilated cardiomyopathy: causes, mechanisms, and current and future treatment approaches. Lancet. 2023 Sep 16;402(10406):998-1011. doi: 10.1016/S0140-6736(23)01241-2.
Merlo M, Cannatà A, Gobbo M, Stolfo D, Elliott PM, Sinagra G. Evolving concepts in dilated cardiomyopathy. Eur J Heart Fail. 2018 Feb;20(2):228-239. doi: 10.1002/ejhf.1103.
Ying C. Viral Myocarditis. Yale J Biol Med. 2024 Dec 19;97(4):515-520. doi: 10.59249/BSHH8575.
McNally EM, Mestroni L. Dilated Cardiomyopathy: Genetic Determinants and Mechanisms. Circ Res. 2017 Sep 15;121(7):731-748. doi: 10.1161/CIRCRESAHA.116.309396.
Wang S, Zhang Z, He J, Liu J, Guo X, Chu H, Xu H, Wang Y. Comprehensive review on gene mutations contributing to dilated cardiomyopathy. Front Cardiovasc Med. 2023 Dec 1;10:1296389. doi: 10.3389/fcvm.2023.1296389.
Domínguez F, Adler E, García-Pavía P. Alcoholic cardiomyopathy: an update. Eur Heart J. 2024 Jul 9;45(26):2294-2305. doi: 10.1093/eurheartj/ehae362.
Hantson P. Mechanisms of toxic cardiomyopathy. Clin Toxicol (Phila). 2019 Jan;57(1):1-9. doi: 10.1080/15563650.2018.1497172.
Bondue A, Arbustini E, Bianco A, Ciccarelli M, Dawson D, De Rosa M, et al. Complex roads from genotype to phenotype in dilated cardiomyopathy: scientific update from the Working Group of Myocardial Function of the European Society of Cardiology. Cardiovasc Res. 2018 Aug 1;114(10):1287-1303. doi: 10.1093/cvr/cvy122.
Orphanou N, Papatheodorou E, Anastasakis A. Dilated cardiomyopathy in the era of precision medicine: latest concepts and developments. Heart Fail Rev. 2022 Jul;27(4):1173-1191. doi: 10.1007/s10741-021-10139-0.
Japp AG, Gulati A, Cook SA, Cowie MR, Prasad SK. The Diagnosis and Evaluation of Dilated Cardiomyopathy. J Am Coll Cardiol. 2016 Jun 28;67(25):2996-3010. doi: 10.1016/j.jacc.2016.03.590.
Peters S, Johnson R, Birch S, Zentner D, Hershberger RE, Fatkin D. Familial Dilated Cardiomyopathy. Heart Lung Circ. 2020 Apr;29(4):566-574. doi: 10.1016/j.hlc.2019.11.018. Epub 2019 Dec 17. PMID: 31974027.
Ferreira A, Ferreira V, Antunes MM, Lousinha A, Pereira-da-Silva T, Antunes D, et al. Dilated Cardiomyopathy: A Comprehensive Approach to Diagnosis and Risk Stratification. Biomedicines. 2023 Mar 9;11(3):834. doi: 10.3390/biomedicines11030834.
Finocchiaro G, Merlo M, Sheikh N, De Angelis G, Papadakis M, et al. The electrocardiogram in the diagnosis and management of patients with dilated cardiomyopathy. Eur J Heart Fail. 2020 Jul;22(7):1097-1107. doi: 10.1002/ejhf.1815.
Harding D, Chong MHA, Lahoti N, Bigogno CM, Prema R, Mohiddin SA, Marelli-Berg F. Dilated cardiomyopathy and chronic cardiac inflammation: Pathogenesis, diagnosis and therapy. J Intern Med. 2023 Jan;293(1):23-47. doi: 10.1111/joim.13556.
Liu C, Ferrari VA, Han Y. Cardiovascular Magnetic Resonance Imaging and Heart Failure. Curr Cardiol Rep. 2021 Mar 8;23(4):35. doi: 10.1007/s11886-021-01464-9.
Ezekowitz JA, O'Meara E, McDonald MA, Abrams H, Chan M, et al. 2017 Comprehensive Update of the Canadian Cardiovascular Society Guidelines for the Management of Heart Failure. Can J Cardiol. 2017 Nov;33(11):1342-1433. doi: 10.1016/j.cjca.2017.08.022.
Merlo M, Cannatá A, Vitagliano A, Zambon E, Lardieri G, Sinagra G. Clinical management of dilated cardiomyopathy: current knowledge and future perspectives. Expert Rev Cardiovasc Ther. 2016;14(2):137-40. doi: 10.1586/14779072.2016.1125292.
Hu J, Xu J, Tan X, Li D, Yao D, et al. Dapagliflozin protects against dilated cardiomyopathy progression by targeting NLRP3 inflammasome activation. Naunyn Schmiedebergs Arch Pharmacol. 2023 Jul;396(7):1461-1470. doi: 10.1007/s00210-023-02409-5.
Ebert M, Richter S, Dinov B, Zeppenfeld K, Hindricks G. Evaluation and management of ventricular tachycardia in patients with dilated cardiomyopathy. Heart Rhythm. 2019 Apr;16(4):624-631. doi: 10.1016/j.hrthm.2018.10.028.
McBenedict B, Hauwanga WN, Amadi ES, Yau MCY, Amuzie CR, et al. The Role of Ventricular Assist Devices in Patients With Heart Failure Due to Dilated Cardiomyopathy: A Systematic Review. Cureus. 2024 Aug 6;16(8):e66259. doi: 10.7759/cureus.66259.
Dandel M. Cardiological Challenges Related to Long-Term Mechanical Circulatory Support for Advanced Heart Failure in Patients with Chronic Non-Ischemic Cardiomyopathy. J Clin Med. 2023 Oct 10;12(20):6451. doi: 10.3390/jcm12206451.
Sorella A, Galanti K, Iezzi L, Gallina S, Mohammed SF, et al. Diagnosis and management of dilated cardiomyopathy: a systematic review of clinical practice guidelines and recommendations. Eur Heart J Qual Care Clin Outcomes. 2024 Dec 14:qcae109. doi: 10.1093/ehjqcco/qcae109.
Fatkin D, Huttner IG, Kovacic JC, Seidman JG, Seidman CE. Precision Medicine in the Management of Dilated Cardiomyopathy: JACC State-of-the-Art Review. J Am Coll Cardiol. 2019 Dec 10;74(23):2921-2938. doi: 10.1016/j.jacc.2019.10.011.
Khayata M, Al-Kindi SG, Oliveira GH. Contemporary characteristics and outcomes of adults with familial dilated cardiomyopathy listed for heart transplantation. World J Cardiol. 2019 Jan 26;11(1):38-46. doi: 10.4330/wjc.v11.i1.38.
Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales R. et al; ESC Scientific Document Group. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J. 2023 Oct 1;44(37):3503-3626. doi: 10.1093/eurheartj/ehad194.
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2025 Ibeth Melissa Chusquillo Calapiña, Pablo Geovanny Alvarado Zambrano, John Jairo Salgado Calderon, Diego Esteban Illescas Leon, José Alberto Mieles Cardenas, Isaac Esteban Navas Trujillo, Stefanny Solange Hidrobo Palacios, Jennifer Cristina Baquero Basantes
Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
