[Music playing] [Text on screen: Ohio State Health & Discovery Health Talks] Gail Hogan: Welcome to Health Talks. I'm Gail Hogan. [Text on screen: The James The Ohio State University Wexner Medical Center] Did you know that about one in 250 Americans have a common but serious heart condition? Dr. Ray Hershberger is here to share what everyone should know. Dr. Hershberger, welcome. Ray Hershberger, MD: Thank you. [Text on screen: Gail Hogan Host Health Talks] Gail Hogan: Let me start by having you explain what dilated cardiomyopathy is. [Music fades] [Text on screen: Ray Hershberger, MD Advanced Heart Failure and Transplant Cardiology Ohio State University Wexner Medical Center] Ray Hershberger, MD: Dilated cardiomyopathy is a heart muscle disease where the heart muscle weakens, the heart enlarges, and the squeeze, instead of being really excellent, is weak. The heart is enlarged and it's pumping not nearly as strongly as it should. Gail Hogan: Does it happen when you're a certain age? Does this happen more in older folks? Does it happen because of family relations, genetic? Ray Hershberger, MD: There are two major types. One is from heart attack or heart, myocardial infarction. That's about half of the cause. The other half is genetic. And in the genetic cause, which is what we call dilated cardiomyopathy, and that's what I will refer to now, dilated cardiomyopathy is a genetic cause. And that happens, in general, with patients who are in their 30s and 40s, although it can occur in children, even infants at times, and then also in older people. Gail Hogan: Are there signs? What do you look for? Ray Hershberger, MD: The problem with dilated cardiomyopathy is that it's silent until it finally presents with what we call late phase disease. That late phase disease is heart failure most of the time. Occasionally, with arrhythmia, could even be ventricular tachycardia or even sudden cardiac death, and then once in a while, an embolus from a blood clot in the heart that would cause a stroke or other organ dysfunction. [Text on screen: Gail Hogan Host Health Talks] Gail Hogan: So by the time you find, as a patient, that you have DCM, it's already progressed? [Text on screen: Ray Hershberger, MD Advanced Heart Failure and Transplant Cardiology Ohio State University Wexner Medical Center] Ray Hershberger, MD: That's correct. In fact, the biggest issue is that dilated cardiomyopathy is silent clinically, even though you might have it. And that's why when patients come in with a newly diagnosed dilated cardiomyopathy, we recommend genetic testing. And then also that their family members, their first degree relatives, that would be parents, siblings, or children, should have clinical screening to make sure they don't have it. Gail Hogan: So apparently, Black Americans are more susceptible to this. Ray Hershberger, MD: I wouldn't necessarily say susceptible. Our studies show that the frequency of familial cardiomyopathy is more in Black Americans than White Americans. Why that is, we're not certain yet. Gail Hogan: So you're still doing testing to try to figure out where this goes from here? Ray Hershberger, MD: Yeah. So again, in, we do large genetic studies that are always family-based. We just completed a study of over 1,200 patients and over 2,000 of their family members to try to understand dilated cardiomyopathy genetics. Gail Hogan: Who should be screened? Ray Hershberger, MD: With a new diagnosis of dilated cardiomyopathy in a patient, the people who need clinical screening are their first degree relatives. Parents, siblings, children. That is clinical screening. That would be an electrocardiogram and an echo, but also genetic screening with genetic testing. [Text on screen: Gail Hogan Host Health Talks] Gail Hogan: Once someone does develop DCM, what are treatments at that point? [Text on screen: Ray Hershberger, MD Advanced Heart Failure and Transplant Cardiology Ohio State University Wexner Medical Center] Ray Hershberger, MD: The good news is is that for dilated cardiomyopathy, we have numerous medical treatments, drugs, that will actually stabilize and commonly improve heart function. So some of the other cardiomyopathies, we cannot do that, but in dilated cardiomyopathy, we can generally get patients better. Gail Hogan: What led you to study this? Ray Hershberger, MD: I started studying dilated cardiomyopathy back when I was an assistant professor. Before we understood that dilated cardiomyopathy was genetic, we called it idiopathic dilated cardiomyopathy. Gail Hogan: Meaning we didn't know- Ray Hershberger, MD: Idiopathic means we don't know what caused it. But it became clear, based upon some early literature, that it ran in families. And if it ran in families, it needed to be genetic. So I started genetic studies, collecting families to study, back in the 1990s. And that has evolved into the current research programs. [Text on screen: Gail Hogan Host Health Talks] Gail Hogan: And as that research, have you been able to help people realize that they may be susceptible to this or already have it at an earlier stage? [Text on screen: Ray Hershberger, MD Advanced Heart Failure and Transplant Cardiology Ohio State University Wexner Medical Center] Ray Hershberger, MD: Yes. Our family studies clearly show when we do our, particularly, larger family studies, we will commonly find first-degree relatives that have dilated cardiomyopathy and they didn't know it. Gail Hogan: So some of the treatment is available here at Ohio State for these patients. Ray Hershberger, MD: Oh, for sure. Ohio State... Generic or usual guideline-directed medical therapy for dilated cardiomyopathy is nearly universal. What Ohio State has though, of course, is advanced therapies. This would be heart transplant. I'm a transplant cardiologist. We also have the mechanical pumps, the ventricular assist devices to help bridge patients to transplant, and then a lot of other important devices, pacemakers, biventricular pacemakers, and all of those types of devices. Gail Hogan: And is the research continuing? Ray Hershberger, MD: We just completed a very large $12.5 million study over 1,200 patients and there are over 2,000 family members. We now have a grant under review to obtain funds to continue to study the family members to understand how dilated cardiomyopathy actually starts and evolves over time at very early stages. The trick is with families, if you know their genetic risk, you can then do clinical screening with echoes, and we're using an advanced echo approach called strain imaging. With strain imaging, we can actually detect very early evidence of DCM. We would hope that the data from that study, if it's funded, could then get us into a situation where we could take forward a randomized study to show that that actually works to really prevent dilated cardiomyopathy. [Text on screen: Gail Hogan Host Health Talks] Gail Hogan: What you're looking to do is tag some of these patients and follow their progress, basically. [Text on screen: Ray Hershberger, MD Advanced Heart Failure and Transplant Cardiology Ohio State University Wexner Medical Center] [Music playing] Ray Hershberger, MD: Well, so, genetics is really one thing. It's risk. Once you understand risk in a patient or a family member, then you can ideally come up with a strategy to prevent the development of dilated cardiomyopathy, or if they have it an early stage, treat it before it gets to advanced strain stage disease. So, again, I'm a transplant cardiologist. We've taken care of the very sickest people in doing heart transplant. It's wonderful, it works, but if we can prevent advanced disease so that we can intervene before patients get that far down that pathway to needing a heart transplant, that would be wonderful. Gail Hogan: Dr. Hershberger, great. Thank you so much. Ray Hershberger, MD: My pleasure. Gail Hogan: And thank you for joining us for Health Talks. [Text on screen: Ohio State Health & Discovery Health Talks health.osu.edu] [Music ends]