Pattern and Evolution of C4d Staining of Ischemic Myocardial Injury: Implications for the Interpretation of Post-Transplant Endomyocardial Biopsies

Hudacko, Rachel; Varghese, Sumi; Fyfe, Billie

doi:10.7156/v5i2p064

Cited by 2 publications

(2 citation statements)

References 15 publications

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“…In addition, a recent study reported that immunohistochemical staining was strongly positive for C4d antigen along the microvasculature and in cardiomyocytes with contraction band necrosis in a fatal case of takotsubo cardiomyopathy, in which myocardial injury appears to be due to excessive circulating catecholamines (as occurs in cases of pheochromocytoma) 36. Finally, it should be noted that, according to some authors, cases in which supposedly necrotic cardiomyocytes test negative for C4d should be interpreted as cases of artifactual contraction band injury 37…”

Section: Discussionmentioning

confidence: 99%

Pheochromocytoma-induced shock: a case report

Araújo¹,

Carmo²,

Júnior³

et al. 2012

ACR

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Because of its rarity, together with the variability and nonspecificity of its signs and symptoms, pheochromocytoma, a tumor arising from chromaffin cells, creates an unlucky paradox: it is often missed but only rarely found. Besides the association with arterial hypertension, often in the form of paroxysmal attacks, pheochromocytoma may also be associated, in up to 40% of cases, with orthostatic hypotension which, when present, provides a clue to the diagnosis of the tumor. Far more rare (about 2% of cases) is the clinical presentation in the form of shock, a possibility that, among other attributes, justifies the epithet “the great mimic” applied to the neoplasia. The authors report the case of a 51-year-old hypertensive woman whose death was erroneously attributed to septic shock. Autopsy disclosed an unsuspected left adrenal bulky pheochromocytoma with areas of hemorrhage and extensive central necrosis, pronounced pulmonary edema, left ventricular mural thrombus, and histological evidence of acute myocardial injury.

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Section: Discussionmentioning

confidence: 99%

Pheochromocytoma-induced shock: a case report

Araújo¹,

Carmo²,

Júnior³

et al. 2012

ACR

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“…The utility of C4d deposition to detect early myocardial infarction may help in the interpretation of perioperative ischemic injury [11,22]. The intensity of microvascular C4d staining may differ during humoral rejection as compared with myocardial infarction alone [22].…”

Section: Discussionmentioning

confidence: 99%

C4d Deposition Reveals Myocardial Infarction After Cardiac Arrest -Experimental Study

Vuohelainen¹,

Paavonen²,

Hämäläinen³

et al. 2015

Adv Clin Exp Med

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Background. The diagnosis of regional myocardial infarction (MI) after cardiac arrest and ischemia-reperfusion injury (IRI) is a major clinical challenge. Objectives. We evaluated in a rat cardiac transplantation model whether IRI alone or with MI would induce complement C4d deposition. Material and Methods. Isogenic heterotopic cardiac transplantation was performed in 16 Fischer 344 rats to induce IRI, of which 9 rats also underwent ligation of the left anterior coronary artery (LAD) of the heart to yield MI. Histology and qRT-PCR for endothelial nitric oxide synthase (eNOS), inducible nitric oxide synthase (iNOS) and transforming growth factor β (TGFβ) were performed after cessation of heart beat. C4d was evaluated by immunohistochemistry. Results. Myocardial inflammation and C4d deposition was increased in grafts with IRI+MI as compared with IRI (0.71 vs. 0.14, PSU, respectively, p < 0.04 and 80.13 vs. 20.29, PSU, respectively, p < 0.02). The expression of eNOS decreased in grafts with IRI + MI as compared with IRI (p < 0.05). Receiver operating characteristic (ROC) curve analysis showed that IRI + MI was associated with C4d deposition (AUC 0.837; S.E. 0.116; p = 0.035; 95% C.I. 0.610-1.000). Conclusions. Increased C4d deposition may be amenable to identify early MI after cardiac arrest. Early treatment aimed towards complement activation may provide a novel means for induced MI after cardiac arrest (Adv Clin Exp Med 2015, 24, 3, 393-399).

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Pattern and Evolution of C4d Staining of Ischemic Myocardial Injury: Implications for the Interpretation of Post-Transplant Endomyocardial Biopsies

Cited by 2 publications

References 15 publications

Pheochromocytoma-induced shock: a case report

Pheochromocytoma-induced shock: a case report

C4d Deposition Reveals Myocardial Infarction After Cardiac Arrest -Experimental Study

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