Chemotherapeutic agents such as anthracyclines, tyrosine kinase inhibitors, trastuzumab, and interferons induce cardiomyopathy. There is a higher risk for cardiomyopathy with higher cumulative dose of chemotherapy, combination with other chemotherapeutic agents, associated radiation, and higher age. Acute cardiac changes can be seen as early as in a few hours after initiation, whereas late changes may be seen over decades with LV dilation and EF decrease, which limits the aggressive use of chemotherapy [83]. Peripartum cardiomyopathy is an idiopathic cardiomyopathy seen either in the late stage of pregnancy or in the first 5 months after delivery [84]. It is seen in 1 in 2,500 to 4,000 births in the United States [84]. Risk factors for peripartum cardiomyopathy include age >30 years, nonwhite background, multiparity, poor socioeconomic status, Nonischemic Myocardial Disease prolonged tocolytic therapy, hypertension, preeclampsia, and cocaine use [85]. These patients are evaluated with ECG, serological biomarkers, and imaging tests. Endomyocardial biopsy may be needed to exclude myocarditis. Several types of inherited muscular dystrophies can also produce DCM. These muscular dystrophies present with HF, arrhythmia, or sudden death by thromboembolism. There are several unclassified NICMs. LV noncompaction is characterized by prominent trabeculations due to persistent embryonic sinusoids, leading to LV failure, thromboembolism, and arrhythmias [86]. Stress-induced cardiomyopathy (also known as Takotsubo cardiomyopathy) is characterized by transient LV systolic dysfunction attributed to catecholamine release, possibly following a stressful event. It presents similarly to acute myocardial infarction with chest pain, ST-segment elevation on ECG, and elevated cardiac enzymes. It accounts for 2% of myocardial infarction with nonobstructive coronary arteries (MINOCA) [87].
Nonischemic Myocardial Disease with Clinical Manifestations Ischemic Cardiomyopathy Already Excluded . Chemotherapeutic agents such as anthracyclines, tyrosine kinase inhibitors, trastuzumab, and interferons induce cardiomyopathy. There is a higher risk for cardiomyopathy with higher cumulative dose of chemotherapy, combination with other chemotherapeutic agents, associated radiation, and higher age. Acute cardiac changes can be seen as early as in a few hours after initiation, whereas late changes may be seen over decades with LV dilation and EF decrease, which limits the aggressive use of chemotherapy [83]. Peripartum cardiomyopathy is an idiopathic cardiomyopathy seen either in the late stage of pregnancy or in the first 5 months after delivery [84]. It is seen in 1 in 2,500 to 4,000 births in the United States [84]. Risk factors for peripartum cardiomyopathy include age >30 years, nonwhite background, multiparity, poor socioeconomic status, Nonischemic Myocardial Disease prolonged tocolytic therapy, hypertension, preeclampsia, and cocaine use [85]. These patients are evaluated with ECG, serological biomarkers, and imaging tests. Endomyocardial biopsy may be needed to exclude myocarditis. Several types of inherited muscular dystrophies can also produce DCM. These muscular dystrophies present with HF, arrhythmia, or sudden death by thromboembolism. There are several unclassified NICMs. LV noncompaction is characterized by prominent trabeculations due to persistent embryonic sinusoids, leading to LV failure, thromboembolism, and arrhythmias [86]. Stress-induced cardiomyopathy (also known as Takotsubo cardiomyopathy) is characterized by transient LV systolic dysfunction attributed to catecholamine release, possibly following a stressful event. It presents similarly to acute myocardial infarction with chest pain, ST-segment elevation on ECG, and elevated cardiac enzymes. It accounts for 2% of myocardial infarction with nonobstructive coronary arteries (MINOCA) [87].