Abstract 4016: Selenium and Zinc Deficient Cardiomyopathy in Human Intestinal Malabsorption
Background: Patients with intestinal malabsorption may develop cardiac arrhythmias and/or dysfunction which origin is often elusive.
Methods: Five patients (5F, mean age 23±7 ys) with celiac disease and 3 patients with intestinal bypass because of severe obesity (2M, 1F mean age 57±3 ys, time from intervention 15±3 ys) presenting unexplained left ventricular (LV) dilatation (LVEDD 68±5 mm) and dysfunction (LVEF 28±5%), underwent LV endomyocardial biopsy. Biopsy samples were processed for histology, electron-microscopy, polymerase chain reaction (PCR) for cardiotropic viruses and instrumental neutron activation analysis (INAA) of myocardial trace elements. Myocardial anti-oxidant reserve and cell autophagy were evaluated by assessment of glutathione peroxidase activity and of LC3-II, respectively. Controls were surgical samples from patients with mitral stenosis and biopsy samples from patients with idiopathic dilated cardiomyopathy.
Results: Histology and electronmicroscopy showed in malabsorption population hypertrophy/degeneration of myocardiocytes with pronounced cell autophagy, confirmed by increased LC3-II. PCR was negative for viral genomes. INAA showed severe myocardial deficiency of Se and Zn (p<0.001). and.. educed myocardial Glutathione peroxidase activity (p<0.001) vs both idiopathic dilated cardiomyopathy and normal controls. Se and Zn infusion was followed at 6 months by a significant recovery of LV function (LVEF 42±4.0%).
Conclusions: A Se and Zn deficient Cardiomyopathy may occur in patients with chronic intestinal malabsorption. It is characterized by decline of myocardial anti-oxidant reserve, oxidative damage of cell membrane and enhanced cell autophagy.