Pragmatic electrocardiogram tracings in non-ischaemic dilated cardiomyopathy: diagnostic and prognostic role

Figures

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  Figure 1. Electrocardiogram of a post-myocarditis DCM. In this, figure is presented in the panel A the electrocardiogram of a 21-year-old male, with a severe left ventricle systolic dysfunction, who is further worsening LVEF and ventricular volumes despite optimized medical therapy. There is also a worsening of the arrhythmic burden. Fundamental from the prognostic point of view in this ECG is the enhancement of the low voltages of the QRS in particular in the peripheral derivations, which suggests the loss of muscle tissue due to fibro-adipose replacement as shown in panels B and C. LVEF, left ventricle ejection fraction; ECG, electrocardiogram; DCM, dilated cardiomyopathy.

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  Figure 2. A genetic diagnosis suggested at the electrocardiogram. In this, figure is presented in the panel A the electrocardiogram of a 41-year-old man, with a DCM genetically determined by a likely pathogenic mutation in the Filamin C gene. The main aspect of the electrocardiogram is based on the infero-lateral repolarization abnormalities, with negative T waves from V3 to V6, isodifasic T waves in DI and aVL and also in inferior leads. The panel B shows the left ventricle dilatation, with mildly reduced left ventricle systolic function with a LVEF of 45%. The panel C shows the typical subepicardial ringlike distribution of LGE involving the inferior, posterior and lateral wall at the CMR. DCM, dilated cardiomyopathy; LVEF, left ventricle ejection fraction; LGE, late gadolinium enhancement; CMR, cardiac magnetic resonance.

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  Figure 3. Left bundle branch block as a marker of unlikely left ventricle reverse remodelling. In this figure is presented in the panel A the electrocardiogram of a 54-year-old man, with an idiopathic DCM with negative genetic test. The main aspect of the electrocardiogram is based on LBBB, which is a marker of unlikely left ventricle reverse remodelling in the context of DCM, and it also represents a therapeutic target to treat with CRT. The panel B and C show the severe left ventricle dilation, respectively in apical four chamber and parasternal long axis. DCM, dilated cardiomyopathy; LBBB, left bundle branch block; CRT, cardiac resynchronization therapy.

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  Figure 4. Electrocardiogram and its therapeutic guidance in sarcoidosis therapy. In this, figure is presented in the panel A the basal electrocardiogram of a 56-year-old man, affected by cardiac sarcoidosis, showing first-degree of atrio-ventricular block, right bundle branch block and QRS complex fragmentation. In the panel C is also presented the PET-TC scan at baseline, showing the important inflammatory activation in the myocardium. In the panel B is presented the ECG during the follow-up, after XX months, during immunosuppressive therapy, and in the panel D it is also presented the control PET-TC scan at XX months in immunosuppressive therapy. ECG, electrocardiogram; PET-TC, positron emission tomography and computed tomography.

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  Figure 5. Cardiac magnetic resonance and histology of cardiac sarcoidosis. In this figure is presented in the panel A the cardiac magnetic resonance of a 56-year-old man, affected by cardiac sarcoidosis, in which is present septal and inferior non-ischaemic LGE in left ventricle and also diffuse LGE in right ventricle. In the panel B, there is a four chamber section showing the patchy LGE distribution in basal interventricular septum, mid-basal lateral wall and free right ventricle wall. In the panels C and D are presented the non-necrotizing granulomas. LGE, late gadolinium enhancement.