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Histopathology of resected myocardium and outcome of partial left ventriculectomy
A T Kawaguchi1, H Ishibashi-Ueda, J Bergsland
1Tokai University School of Medicine, Isehara, Kanagawa, Japan. akira@is.icc.u-tokai.ac.jp
Background:
Since preoperative hemodynamics are not proven to be a predictor of effects of partial left ventriculectomy (PLV), myocardial histopathology may be better correlated with effects and outcome of PLV.
Methods:
Myocyte size (micron) in the excised myocardium was measured in 338 patients undergoing PLV. Endocardial fibrosis, interstitial fibrosis, and inflammatory cell infiltration were enumerated as none = 0, mild = 1, moderate = 2, and severe = 3. These histopathologic observations were correlated with patients' postoperative survival.
Results:
Reduced survival was seen in patients with advanced (> or = moderate) interstitial fibrosis in all patients (n = 338, p = 0.064) and in the subgroup with nonischemic etiology (n = 229, p = 0.0039). Although correlation between endocardial and interstitial fibrosis was significant (r = 0.55, p < 0.01), endocardial fibrosis failed to correlate with postoperative survival. While Chagas' disease was associated with severe inflammation and poor survival, the presence of inflammatory cell infiltration had no effect on survival in all patients combined (p = 0.943). Although most patients (n = 266, 79%) had myocyte diameter over 30 micron, those with less hypertrophy (< 30 micron, n = 70, 21%) had a tendency toward increased survival (p = 0.067) regardless of underlying etiology.
Conclusion:
Interstitial fibrosis may be an important factor in stratification of patients for repair (PLV) or replacement (transplantation). PLV may be more beneficial in patients with less hypertrophy, before develqpment of interstitial fibrosis. Endomyocardial biopsy might not predict the extent or variation in degree of interstitial fibrosis, which may be better evaluated by other metabolic or perfusion studies that measure overall myocardial histopathology and viability.
Insights
Myocardial interstitial fibrosis, not hemodynamics, predicts outcomes after partial left ventriculectomy (PLV). Less hypertrophy and fibrosis correlate with better survival, suggesting fibrosis assessment for patient selection.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pathology
Background:
- Preoperative hemodynamics are not established predictors for partial left ventriculectomy (PLV) outcomes.
- Myocardial histopathology may offer better correlation with PLV efficacy and patient survival.
Purpose of the Study:
- To investigate the correlation between myocardial histopathology and postoperative survival in patients undergoing PLV.
- To determine if myocyte size, interstitial fibrosis, endocardial fibrosis, or inflammatory cell infiltration predict outcomes after PLV.
Main Methods:
- Assessed myocyte size, endocardial fibrosis, interstitial fibrosis, and inflammatory cell infiltration in 338 patients undergoing PLV.
- Correlated histopathological findings with postoperative survival rates.
Main Results:
- Advanced interstitial fibrosis (> or = moderate) was associated with reduced survival (p = 0.064 overall, p = 0.0039 for nonischemic etiology).
- Endocardial fibrosis did not correlate with survival, while severe inflammation in Chagas' disease correlated with poor survival.
- Patients with less myocyte hypertrophy (< 30 micron) showed a tendency toward increased survival (p = 0.067).
Conclusions:
- Interstitial fibrosis is a key factor for stratifying patients for PLV versus transplantation.
- PLV may be more advantageous in patients with less hypertrophy and before significant interstitial fibrosis develops.
- Endomyocardial biopsy may not fully capture interstitial fibrosis; metabolic or perfusion studies might be better for assessing myocardial histopathology and viability.
