CONGRESS ABSTRACT

Dilated cardiomyopathy is conventionally characterized by systolic dysfunction and left ventricular or biventricular dilatation not explained byabnormal loading conditions or coronary artery disease. A 41-year-old man was admitted to the ER with shortness of breath. He complained also flu-like syndrome with productive coughin the previous weeks. He had no history of cardiovascular risk factors,and he wasn't taking anydaily medication. A TTE revealed a left ventricle slightly dilated with global hypokinesis and reduced systolic function, symmetric tethering of mitral leaflets with associated moderate-to-severe mitral regurgitation. The patient was then admitted to our intensive care unit with a diagnosis of suspected myocarditis. In our ward a severe hypocalcemia (2.52 mg/dl, RR 8.60 – 10.20) was found in blood tests, with associated hyperphosphatemia, hypokalemia, hypomagnesemia and reduced PTH. TSH, FT3, FT4, TPOAb, TRAb, urinary calcium and vit-D were normal.Collecting a more detailedmedical history we found that the patient had clinical manifestations compatible with Trousseau's sign for several years, hypocalcemia (6.3 mg/dl) and hyperphosphatemia (7.6 mg/dl) to previous blood tests, and prolonged QT interval to a previous ECG. Coronary angiography showed no coronary stenosis. Cardiac CMR showed severe dilation and diffuse hypokinesiaof both ventricles, without late gadolinium enhancement. Hypocalcaemicdilated cardiomyopathy was diagnosed, probably caused by primary hypoparathyroidism. The patient was treated with high dose of calcium carbonateand calcitriol, with normalization of serum calcium levelsand disappearance of signs and symptoms of hypocalcemia.After two weeks of optimized HFrEF therapywith sacubitril/valsartan, empagliflozin, beta blocker and spironolactone, left ventricle EF did not improve. Therefore, an ICD was implanted. One month after discharge, in the followup echocardiographic evaluation, LV EF and EDVI were improved.Hypocalcemia is a reversible cause of dilated cardiomyopathy that warrants attention, especially in patients with electrolyte imbalances. Regular monitoring of calcium and magnesium levels, especially in patients with hypoparathyroidism or a history of thyroidectomy and prompt recognition and treatment can improve cardiac function and potentially reverse symptoms of DCM, with a favorable outcome. Further studies are needed to better understand the mechanisms linking hypocalcemia and cardiac dysfunction