The Relation Between Myocardial Lesions and Coronary Artery Disease Ii. A Selected Group of Patients With Massive Cardiac Necrosis or Scarring

Abstract

Our survey of the relation between cardiac lesions and coronary disease in an unselected necropsy sample (Schwartz and Mitchell, 1962) showed that large areas of necrosis or scarring were associated with severe coronary narrowing and with coronary occlusion. To study these lesions in more detail we have collected a further 64 patients with large lesions. The findings in these selected patients together with the 15 patients with large lesions from the random survey are reported here. MATERIAL AND METHODSDuring the period of study, when every tenth necropsy carried out on patients aged 35 and over at the Radcliffe Infirmary, Oxford, was being included in our unselected survey, we also collected the heart and great vessels from every patient who fulfilled one or more of the following criteria: a clinical history of (a) severe retrosternal chest pain lasting for more than an hour; (b) a sudden reduction in blood pressure, or the onset of cardiac failure or the development of an arrhythmia, for which no adequate clinical explanation could be found; or (c) sudden death in patients from whom no history was elicited and at necropsy, the organs, other than the heart, provided no explanation for the patient's death.In addition any patient with the following electrocardiographic findings was included: (a) patients with pathological Q waves, and (b) patients without pathological Q waves in whom serial records had shown changing ST-T patterns.If the external appearance of the heart of patients at necropsy demonstrated an area of ventricular discoloration and softening, often with an overlying pericarditis, or in the case of older lesions, an area of ventricular thinning, usually with an overlying pericarditis, they were included.By selecting for study all the cases in which a large lesion might be present, we hoped to collect a consecutive series of large lesions concurrently with the unselected, random sample.The hearts were injected, radiographed, fixed, serially sectioned on the bacon slicer, cleared, and finally examined histologically in exactly the same way as described for the unselected series. As in the unselected sample, the uncleared heart sections, the cleared sections, and the histological preparations were examined by the authors jointly, and the lesions were described and measured without any knowledge of the clinical, electrocardiographic, or arterial status of the patient: indeed they were examined concurrently with the random sample and, as all hearts were identified only by an experiment number, we had no knowledge of the mode of selection of the heart under examination. Where a large lesion was found, we assigned a histological age to it, on this preliminary "blind" examination, using the criteria described by Mallory, White, and Salcedo-Salgar (1939). RESULTSA. Composition of Series Of 70 hearts selected on the above criteria, 64 were found on examination to have large lesions, and it is these 64 together with the 15 patients with large lesions from the random survey, that we propose to discuss here.

The relationship of age, blood pressure, serum cholesterol and smoking habits with the risk of typical and atypical coronary heart disease death in the European cohorts of the Seven Countries Study

“…This problem goes back many years when pathological findings suggested that the frequency distribution of the size of myocardial scars seems bimodal in nature, indicating the possible existence of different pathophysiological processes in their production and consequences [16]. In that study, large myocardial replacement lesions (section length of 4-10 cm) were clearly related to coronary atherosclerosis and obstruction, whereas small replacement lesions (section length of 2.5 cm or less) were unrelated to coronary atherosclerosis, thrombosis or occlusion and were not more common among patients with myocardial infarction.…”

Lifetime prediction of coronary heart disease and heart disease of uncertain etiology in a 50-year follow-up population study

“…Methods can be quite complex to both define and handle these techniques with a sufficient level of clarity [29]. Our own AP based re-classification effort is a further possible example to stay in balance with the impression that successive historic time periods, state of the art knowledge, opinion leaders' preferences or simply different disciplines [16][17][18][19][20][21][22][23][24][25][26][27][30][31][32] were the driving forces to orient classifications and sometimes missclassifications.…”

“…The literature on this issue is scanty. Some old pathological descriptions differentiated gross coronary atheroma accompanied by large infarction scars from multiple small scars independent from gross coronary lesions and sometimes defined as myocardial fibrosis [16][17][18]. In a more recent contribution it was shown that gross atheroma of coronary vessels is simply more severe in CHD fatal cases than in other conditions [19].…”

Relationship of Some Risk Factors with Typical and Atypical Manifestations of Coronary Heart Disease

“…This problem goes back many years when pathological findings suggested that the frequency distribution of the size of myocardial scars seems bimodal in nature, indicating the possible existence of different pathophysiological processes in their production and consequences [11]. In that study, large myocardial replacement lesions (section length 4-10 cm) were clearly related to coronary atherosclerosis and obstruction, whereas small replacement lesions (section length ^2.5 cm) were unrelated to coronary atherosclerosis, thrombosis or occlusion, and were not more common among patients with myocardial infarction.…”