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Myocardial Fibrosis From Severe Carbon Monoxide Poisoning Detected by Cardiac Magnetic Resonance Imaging

2008; Lippincott Williams & Wilkins; Volume: 118; Issue: 7 Linguagem: Inglês

10.1161/circulationaha.107.750778

1524-4539

Timothy D. Henry, John R. Lesser, Daniel Satran,

Traumatic Brain Injury and Neurovascular Disturbances

HomeCirculationVol. 118, No. 7Myocardial Fibrosis From Severe Carbon Monoxide Poisoning Detected by Cardiac Magnetic Resonance Imaging Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessReview ArticlePDF/EPUBMyocardial Fibrosis From Severe Carbon Monoxide Poisoning Detected by Cardiac Magnetic Resonance Imaging Timothy D. Henry, John R. Lesser and Daniel Satran Timothy D. HenryTimothy D. Henry From the Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital and Departments of Medicine and Cardiology, University of Minnesota, Minneapolis, Minn. , John R. LesserJohn R. Lesser From the Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital and Departments of Medicine and Cardiology, University of Minnesota, Minneapolis, Minn. and Daniel SatranDaniel Satran From the Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital and Departments of Medicine and Cardiology, University of Minnesota, Minneapolis, Minn. Originally published12 Aug 2008https://doi.org/10.1161/CIRCULATIONAHA.107.750778Circulation. 2008;118:792Carbon monoxide (CO) poisoning is a leading cause of toxicological morbidity and mortality. We recently reported 37% of patients with moderate to severe CO poisoning suffered myocardial injury.1 In follow-up, 24% of patients died at a median of 7.6 years, a mortality rate 3 times higher than expected compared with age- and sex-specific US mortality rates. Myocardial injury was the major predictor of mortality: 38% of patients who sustained myocardial injury died compared with 15% without myocardial injury. The precise mechanisms responsible for the increase in mortality remain unclear, but cardiovascular death was more common (44% versus 18%) among patients who initially sustained myocardial injury.2We report a case of myocardial fibrosis after severe CO poisoning detected by cardiac MRI. A previously healthy 63-year-old woman presented to an outside hospital with severe CO poisoning. She was comatose, with an initial carboxyhemoglobin level of 28.6%. Baseline troponin I (0.09 ng/mL) and creatine kinase–MB (7.7 ng/mL) were normal, but serial cardiac biomarkers were not obtained. Admission ECG showed sinus tachycardia with ventricular bigeminy and diffuse ST-depression consistent with ischemia. Her clinical course was complicated by neurological dysfunction. At 4-month follow-up, the ECG and echocardiogram were normal (left ventricular ejection fraction 65% without wall-motion abnormalities). Cardiac adenosine MRI showed no rest or stress-induced myocardial perfusion defects but revealed inferolateral midwall myocardial fibrosis (not in the typical distribution of a coronary artery) that spared the endocardium (Figure). Download figureDownload PowerPointFigure. Left ventricular outflow tract and short-axis MRI views with a double inversion-recovery turbo flash sequence after gadolinium. Arrows show hyperenhancement in the inferolateral midventricular wall.This is the first report of myocardial fibrosis from CO poisoning detected by MRI. Midwall myocardial fibrosis has been reported in dilated cardiomyopathy of unclear origin. In a series of 63 patients, 18 (28%) had midwall enhancement.3 In a follow-up of 101 consecutive patients with dilated cardiomyopathy, midwall fibrosis (present in 35% of patients) predicted a combined end point of all-cause mortality and cardiovascular hospitalization, as well as sudden cardiac death.4 Myocardial fibrosis has also been demonstrated in hypertrophic cardiomyopathy and has been linked to known markers for sudden cardiac death, although the independent prognostic value of MRI has yet to be determined.5 In our case, myocardial fibrosis was present in the setting of a completely normal echocardiogram, which suggests the utility of obtaining cardiac MRI in patients with moderate to severe CO poisoning. The incidence and prognostic significance of myocardial fibrosis after CO poisoning are unclear but deserve further study and may provide a link to adverse long-term outcome for a subset of patients.The online-only Data Supplement is available with this article at http://circ.ahajournals.org/cgi/content/full/118/7/792/DC1.DisclosuresNone.FootnotesCorrespondence to Timothy D. Henry, MD, Minneapolis Heart Institute Foundation, 920 East 28th St, Minneapolis, MN 55407. E-mail [email protected]References1 Satran D, Henry CR, Adkinson C, Nicholson CI, Bracha Y, Henry TD. Cardiovascular manifestations of moderate to severe carbon monoxide poisoning. J Am Coll Cardiol. 2005; 45: 1513–1516.CrossrefMedlineGoogle Scholar2 Henry CR, Satran D, Lindgren B, Adkinson C, Nicholson CI, Henry TD. Myocardial injury and long-term mortality following moderate to severe carbon monoxide poisoning. JAMA. 2006; 295: 398–402.CrossrefMedlineGoogle Scholar3 McCrohon JA, Moon JC, Prasad SK, McKenna WJ, Lorenz CH, Coats AJ, Pennell DJ. Differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease using gadolinium-enhanced cardiovascular magnetic resonance. Circulation. 2003; 108: 54–59.LinkGoogle Scholar4 Assomull RG, Prasad SK, Lyne J, Smith G, Burman ED, Khan M, Sheppard MN, Poole-Wilson PA, Pennell DJ. Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy. J Am Coll Cardiol. 2006; 48: 1977–1985.CrossrefMedlineGoogle Scholar5 Moon JC, McKenna WJ, McCrohon JA, Elliott PM, Smith GC, Pennell DJ. Toward clinical risk assessment in hypertrophic cardiomyopathy with gadolinium cardiovascular magnetic resonance. J Am Coll Cardiol. 2003; 41: 1561–1567.CrossrefMedlineGoogle Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsCited By Henry T and Satran D (2021) Acute Carbon Monoxide Poisoning and Cardiac Magnetic Resonance, JACC: Cardiovascular Imaging, 10.1016/j.jcmg.2021.06.024, 14:9, (1771-1773), Online publication date: 1-Sep-2021. Cho D, Ko S, Son J, Park E and Cha Y (2021) Myocardial Injury and Fibrosis From Acute Carbon Monoxide Poisoning, JACC: Cardiovascular Imaging, 10.1016/j.jcmg.2021.02.020, 14:9, (1758-1770), Online publication date: 1-Sep-2021. Al-Owais M, Steele D, Holden A and Benson A (2021) Deterministic and Stochastic Cellular Mechanisms Contributing to Carbon Monoxide Induced Ventricular Arrhythmias, Frontiers in Pharmacology, 10.3389/fphar.2021.651050, 12 Underner M, Perriot J, Peiffer G, Dewitte J and Jaafari N (2021) Republication de : Intoxication au monoxyde de carbone chez les fumeurs actifs ou passifs de chicha, Journal Européen des Urgences et de Réanimation, 10.1016/j.jeurea.2021.01.005, 33:1, (33-45), Online publication date: 1-Mar-2021. 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August 12, 2008Vol 118, Issue 7 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.107.750778PMID: 18695205 Originally publishedAugust 12, 2008 PDF download Advertisement SubjectsComputerized Tomography (CT)