Myocardial Inflammatory Cell Infiltrates in Cases of Dilated Cardiomyopathy as a Determinant of Outcome Following Partial Left Ventriculectomy.

Abstract

eart transplantation has been used to treat dilated cardiomyopathy (DCM) in patients in whom medical therapy or a left ventricular assist device has failed. However, there are a limited number of hearts available for transplantation, and many patients die while awaiting transplantation. Recently, partial left ventriculectomy (PLV; the Batista procedure) 1-6 has received attention as an alternative or bridging treatment for severe cardiomyopathies. In this operation, the surgeon partially resects the left ventricle in an attempt to decrease left ventricular wall tension by reducing chamber volume. Therefore it is necessary to establish the indications for this procedure and to determine the prognosis following this surgery.Immunologic abnormalities, viral infections, and genetic predisposition are possible factors involved in the development of myocardial injury in DCM. 7 The presence of inflammatory cell infiltrates [8][9][10][11] and viral genomes [12][13][14][15] 16,17 It is therefore quite important to determine the role of inflammatory cell infiltrates or active myocarditis in the development of DCM.The histopathologic features of myocardial injury and the severity of cardiomyopathy are considered to be factors determining the prognosis following PLV. We previously reported that severe inflammatory cell infiltration might serve as a predictor of poor outcome, 18,19 but we could not determine a significant correlation between any histopathologic findings and the early prognosis of patients with DCM following PLV, because the number of patients was too small.The purpose of present study was to determine the involvement of active myocarditis in DCM using histopathologic, immunohistochemical and virologic studies of myocardial specimens obtained by PLV. In addition, this study aimed to determine the relationship between the histopathologic findings and the early prognosis of patients with DCM following PLV using more histopathologic factors in a larger number of cases compared with our previous study. 18,19 Jpn Circ J 2001; 65: 797 -802 (Received October 27, 2000; revised manuscript received May 28, 2001; accepted June 11, 2001 Yasuhiro Horii, MD*; Tadashi Isomura, MD*; Hisayoshi Suma, MD* Partial left ventriculectomy (PLV) can be used to treat refractory congestive heart failure caused by dilated cardiomyopathy (DCM). In order to understand the relationship between the underlying myocardial injury and early clinical outcomes after PLV, histopathologic, immunohistochemical and virologic studies of the resected myocardium were performed. The posterolateral left ventricular walls from 27 patients with idiopathic DCM were examined. Cardiomyocyte diameter, degree of myocardial fibrosis, degree of cardiomyocyte degeneration, and degree of inflammatory cell infiltration were compared with mortality rates. Polymerase chain reaction was performed to detect enterovirus genome in the myocardium. Some patients had inflammatory cell infiltrates with focal accumulations of lymphocytes and macrophages, including both cytot...

Autophagic Degeneration as a Possible Mechanism of Myocardial Cell Death in Dilated Cardiomyopathy.

“…10,11 Specimens of left ventricular myocardium, resected during surgery, were examined and for the control, 5 autopsied hearts from patients who had died of non-cardiac diseases were used.…”

The Mononuclear Phagocyte System in Homeostasis and Disease: A Role for Heme Oxygenase-1

“…The phenotypes of MP are heterogeneous and dependent on the microenvironment that they inhabit (15,44,62). There is evidence that tissue homeostasis is subject to regulation by tissue resident MP, and that multiple modes of communication exist between parenchymal cells and resident MP (64,81,82,146,181,191). In the heart, for example, resident macrophages express high levels of HO-1 and CD163 and directly interact with endothelial cells and cardiac myocytes (134).…”

Arachidonic Acid Metabolism as a Potential Mediator of Cardiac Fibrosis Associated with Inflammation

“…Furthermore, histological analysis of myocardial biopsies from patients with dilated cardiomyopathy revealed myocardial damage, severe interstitial fibrosis (up to 41%), and the influx of lymphocytes and macrophages (3). In inflammatory cardiomyopathic patients, Pauschinger et al (13) found an increased collagen I to III ratio, which suggested a role for inflammation in not only eliciting fibrosis but also adversely altering the ratio of collagen isoforms in the heart.…”

“…This pathological process is intimately associated with numerous cardiovascular diseases including hypertension, myocarditis, dilated cardiomyopathy, myocardial infarction (MI), and heart failure. In many of these pathologies, inflammatory cells have been observed to be spatially and temporally associated with cardiac fibrosis (1)(2)(3)(4).…”