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Sophie Mavrogeni, MD; Antigoni Papavasiliou, MD
Author and Funding Information

From Onassis Cardiac Surgery Center (Dr Mavrogeni) and Penteli Children’s Hospital (Dr Papavasiliou).

Correspondence to: Sophie Mavrogeni, MD, 50 Esperou St, 175-61 P.Faliro, Athens, Greece; e-mail: soma13@otenet.gr


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(3):757. doi:10.1378/chest.10-1297
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To the Editor:

Finsterer and Stöllberger present some interesting comments on our article about cardiac and sternocleidomastoid muscle involvement in Duchenne muscular dystrophy (DMD) studied by MRI.1 We underestimated neither the importance of clinical neurologic and cardiac examination, nor the use of the currently applied techniques in the assessment of DMD patients. Although the technologic progress is of great value, there is no doubt that the patient’s clinical evaluation remains the cornerstone of medicine.

In this article, our purpose was not to underestimate the value of traditionally used approaches; instead, we emphasized the important role of a new technology in the early detection of subclinical cases. The same findings were assessed by other authors,2-4 and recently more MRI articles have emphasized the importance of the technique in the early detection of subclinical lesions in DMD patients.5,6 This is to be expected because MRI has the ability to detect little changes very early in different tissues.

We should also emphasize that DMD patients can nowadays have different clinical presentations, depending on the early use of angiotensin-converting enzyme inhibitors and/or deflazacort, the patient’s supportive treatment, close cardiac and neurologic evaluation, and so forth. Cardiac involvement is not necessarily found in all patients at the time of ambulation loss. Additionally, ECG changes are not necessarily found in all DMD patients.7 Furthermore, the pathophysiology of cardiac lesions in DMD is more complicated than initially believed. Although it is known that the absence or decrease of dystrophin leads to progressive skeletal muscle and heart failure, it has also been documented recently that abnormal dystrophin can act as a potential susceptibility gene for viral infection of the myocardium and as a factor that markedly increases enterovirus-induced cardiomyopathy.8

We did not perform Doppler tissue imaging, which can also offer early information about cardiac involvement, and we did not compare our results with new echo techniques because these techniques are not available everywhere and all echocardiographers are not familiar with them. Our purpose was to emphasize the capability of MRI to perform tissue characterization and its possible use for early detection of subclinical cardiac involvement in DMD. Further comparative studies are needed to establish the role of each technique. However, there is no doubt that MRI proved to be of great importance in the early detection and long-term follow-up of many diseases with cardiac involvement and also was able to detect cardiac lesions missed by echocardiography (myocarditis, cardiomyopathies, thalassemia, and so forth).

Mavrogeni S, Tzelepis GE, Athanasopoulos G, et al. Cardiac and sternocleidomastoid muscle involvement in Duchenne muscular dystrophy: an MRI study. Chest. 2005;1271:143-148. [CrossRef] [PubMed]
 
Kim HK, Laor T, Horn PS, Wong B. Quantitative assessment of the T2 relaxation time of the gluteus muscles in children with Duchenne muscular dystrophy: a comparative study before and after steroid treatment. Korean J Radiol. 2010;113:304-311. [CrossRef] [PubMed]
 
Wansapura JP, Hor KN, Mazur W, et al. Left ventricular T2 distribution in Duchenne muscular dystrophy. J Cardiovasc Magn Reson. 2010;121:14. [CrossRef] [PubMed]
 
Dunn JF, Zaim-Wadghiri Y. Quantitative magnetic resonance imaging of the mdx mouse model of Duchenne muscular dystrophy. Muscle Nerve. 1999;2210:1367-1371. [CrossRef] [PubMed]
 
Giglio V, Camastra G, Ansalone G. Myocardial late enhancement in Duchenne and Becker individuals in the clinical milieu. J Am Coll Cardiol. 2007;5020:2019-2020. [CrossRef] [PubMed]
 
Silva MC, Meira ZM, Gurgel Giannetti J, et al. Myocardial delayed enhancement by magnetic resonance imaging in patients with muscular dystrophy. J Am Coll Cardiol. 2007;4918:1874-1879. [CrossRef] [PubMed]
 
Stöllberger C, Winkler-Dworak M, Blazek G, Finsterer J. Association of electrocardiographic abnormalities with cardiac findings and neuromuscular disorders in left ventricular hypertrabeculation/non-compaction. Cardiology. 2007;1074:374-379. [CrossRef] [PubMed]
 
Mavrogeni S, Papavasiliou A, Spargias K, et al. Myocardial inflammation in Duchenne Muscular Dystrophy as a precipitating factor for heart failure: a prospective study. BMC Neurol. 2010;10:33. [CrossRef] [PubMed]
 

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References

Mavrogeni S, Tzelepis GE, Athanasopoulos G, et al. Cardiac and sternocleidomastoid muscle involvement in Duchenne muscular dystrophy: an MRI study. Chest. 2005;1271:143-148. [CrossRef] [PubMed]
 
Kim HK, Laor T, Horn PS, Wong B. Quantitative assessment of the T2 relaxation time of the gluteus muscles in children with Duchenne muscular dystrophy: a comparative study before and after steroid treatment. Korean J Radiol. 2010;113:304-311. [CrossRef] [PubMed]
 
Wansapura JP, Hor KN, Mazur W, et al. Left ventricular T2 distribution in Duchenne muscular dystrophy. J Cardiovasc Magn Reson. 2010;121:14. [CrossRef] [PubMed]
 
Dunn JF, Zaim-Wadghiri Y. Quantitative magnetic resonance imaging of the mdx mouse model of Duchenne muscular dystrophy. Muscle Nerve. 1999;2210:1367-1371. [CrossRef] [PubMed]
 
Giglio V, Camastra G, Ansalone G. Myocardial late enhancement in Duchenne and Becker individuals in the clinical milieu. J Am Coll Cardiol. 2007;5020:2019-2020. [CrossRef] [PubMed]
 
Silva MC, Meira ZM, Gurgel Giannetti J, et al. Myocardial delayed enhancement by magnetic resonance imaging in patients with muscular dystrophy. J Am Coll Cardiol. 2007;4918:1874-1879. [CrossRef] [PubMed]
 
Stöllberger C, Winkler-Dworak M, Blazek G, Finsterer J. Association of electrocardiographic abnormalities with cardiac findings and neuromuscular disorders in left ventricular hypertrabeculation/non-compaction. Cardiology. 2007;1074:374-379. [CrossRef] [PubMed]
 
Mavrogeni S, Papavasiliou A, Spargias K, et al. Myocardial inflammation in Duchenne Muscular Dystrophy as a precipitating factor for heart failure: a prospective study. BMC Neurol. 2010;10:33. [CrossRef] [PubMed]
 
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