Author + information
We thank Drs. Lorscheider and Vimy for their observations. Sarcotubular abnormalities were a common ultrastructural finding in our patients with idiopathic dilated cardiomyopathy, and they may well be related to the extremely high level of mercury in the myocardiocytes. Alterations of beta-tubulin interfering with microtubule organization were reported in idiopathic as well as anthracycline-associated dilated cardiomyopathy (1,2).
As far as the possible origin of mercury from dental amalgam is concerned, we failed to include dental history in the patient questionnaire assessing the environmental exposure to heavy metals and toxic trace elements. However, at a recent follow-up, of the original group of 13 patients with idiopathic dilated cardiomyopathy, 10 (three patients died in the meantime) were specifically questioned about their dental history, five of whom had dental amalgam fillings, but their myocardial mercury concentrations were not significantly higher than that of the others. Finally, the simultaneous myocardial increase of antimony, and to a lesser extent of silver, arsenic, gold, chromium, lanthanum and zinc, in these patients, as well as the concentration of normal trace elements in their skeletal muscle biopsies, makes the pathogenetic role of a dental mercury source rather unlikely.
A cell membrane dysfunction, possibly induced by a myocardial viral infection, such as coxsackie B virus, might be a more plausible explanation.
- American College of Cardiology
- Shaper J.,
- Froede R.,
- Hein S.,
- et al.