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Vascular dysfunction in idiopathic dilated cardiomyopathy

Nature Reviews Cardiology volume 6, pages 590–598 (2009)Cite this article

Abstract

Idiopathic dilated cardiomyopathy (IDCM) is defined as myocardial dilatation and dysfunction in the absence of overt coronary heart disease. Myocardial injury and genetic or environmental factors can lead to the development of IDCM, which was historically characterized by marked abnormalities in the function and integrity of cardiomyocytes. However, cardiac endothelial dysfunction has also been shown to be associated with progression and poor prognosis of IDCM. Moreover, marked vascular derangements and impaired vasculogenic and angiogenic responses have been reported in patients with IDCM. On the basis of these data we re-examine IDCM pathophysiology as a downstream complication of vascular derangements that contribute to myocyte damage. Animal models closely resembling the marked vascular alterations found in patients with IDCM will be of paramount importance for further enhancing our comprehension of disease progression and for testing new drugs and stem-cell or gene-based therapies.

Key Points

  • Analysis of the cardiac vasculature using multislice CT reveals marked side-branch paucity and short, thin epicardial arteries in hearts from patients with idiopathic dilated cardiomyopathy (IDCM)

  • De novo vascular organization of mobilized endothelial progenitors (vasculogenesis) and new blood vessel formation by pre-existing mature endothelial cells (angiogenesis) are altered in patients with IDCM

  • Whether vascular dysfunction contributes to or is a marker of the progression of left ventricular dysfunction in patients with IDCM remains to be established

  • Appropriate in vivo animal models closely resembling the marked vascular alterations will be essential for further enhancing our comprehension of disease progression and for testing new therapies

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Figure 1: Histopathological alterations in IDCM.
Figure 2: Defective vascularization in IDCM.
Figure 3: Increased mobilization of endothelial progenitor cells in IDCM.
Figure 4: Impaired vasculogenesis and angiogenesis in IDCM.
Figure 5: Mechanisms for vascular dysfunction in IDCM.
Figure 6: Proposed mechanism of IDCM pathophysiology.

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Acknowledgements

The authors specially thank C. Prat-Vidal, C. Gálvez Montón and A. Echenique for obtaining, and immunohistochemical processing of, myocardial specimens from the hearts of patients with idiopathic dilated cardiomyopathy, and R. Leta for selection of multislice CT images. The work was supported by grants from the Ministerio de Educación y Ciencia (SAF2004-08,044-C03-01; SAF2008-05,144-C02-01), and Societat Catalana de Cardiologia. We also appreciate support from Fundació Privada Daniel Bravo Andreu. The authors thank the reviewers and editors for invaluable advice.

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  1. ICREC Program, Hospital de la Santa Creu i Sant Pau, Institut Català de Ciències Cardiovasculars (ICCC), Barcelona, Spain

    Santiago Roura & Antoni Bayes-Genis

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Roura, S., Bayes-Genis, A. Vascular dysfunction in idiopathic dilated cardiomyopathy. Nat Rev Cardiol 6, 590–598 (2009). https://doi.org/10.1038/nrcardio.2009.130

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