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Ultrasonic Assessment of Myocardial Microstructure
Published on: January 14, 2014
Differences in coronary microvascular lesions in coronary heart disease and hypertension: an autopsy study of elderly
1Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing 100853, China. lixy@mx.cei.gov.cn
Insights
Coronary microvascular lesions (CML) are more severe in elderly patients with essential hypertension (EHT) and coronary heart disease (CHD). These microvascular changes significantly impact myocardial damage and coronary flow reserve in these patient groups.
Area of Science:
- Cardiovascular Pathology
- Geriatric Medicine
- Microcirculation Research
Background:
- Hypertension leads to microvascular lesions in target organs, preceding arterial arteriosclerosis.
- Coronary microvascular lesion (CML) is a critical factor in target organ damage.
- Understanding CML differences in elderly patients with essential hypertension (EHT), coronary heart disease (CHD), or both is crucial.
Purpose of the Study:
- To investigate and compare the characteristics of CML in autopsies of elderly patients.
- To analyze CML differences in patients with EHT, CHD, or combined EHT and CHD.
- To correlate CML with left ventricular wall thickness (LVWT) across different cardiovascular conditions.
Main Methods:
- Retrospective autopsy study of 3195 cases, focusing on 246 patients over 60 with EHT, CHD, or both, plus 26 controls.
- Histological examination (H&E, EVG, CD31) of cardiac arterioles and capillaries.
- Quantification of CML using arteriole density (AD), arteriole wall-to-lumen ratio (RWL), and capillary density (CD) via image analysis.
Main Results:
- In EHT, increasing LVWT correlated with increased AD and RWL, and decreased CD.
- EHT with CHD showed similar but more severe changes than EHT alone.
- CHD alone exhibited increased AD but no significant changes in RWL or CD with increasing LVWT.
Conclusions:
- Coronary microvascular lesion (CML) severity is significantly greater in elderly patients with combined EHT and CHD.
- Distinct patterns in arteriole wall-to-lumen ratio (RWL) and capillary density (CD) differentiate EHT from CHD.
- CML is a primary contributor to reduced coronary flow reserve and myocardial damage in EHT and EHT with CHD.
Background:
In the case of hypertension, lesions in the microvessels of the target organs precede and deteriorate further after arteriosclerosis in the small arteries. Thus coronary microvascular lesion (CML) was considered the crucial factor contributing to damage to the target organs. The purpose of this study is to observe the characteristics and differences of CML in autopsies of elderly patients with essential hypertension (EHT), coronary heart disease (CHD), or EHT with CHD, given the same degree of left ventricular wall thickness (LVWT).
Methods:
A retrospective study was performed on 246 cases of patients over 60 years old with EHT, CHD, or EHT with CHD, and on 26 cases without cardiovascular disease as controls, out of a total of 3195 consecutive autopsied cases. The arterioles (with diameter 10 - 60 microm) and the capillaries in the cardiac muscle layer were examined by haematoxylin and eosin staining, elastic van Gieson staining, and CD31 immunohistochemistry. To quantify CML severity, measurements were taken of arteriole density (AD), the ratio of wall-to-lumen area of arteriole (RWL), and capillary density (CD), using light microscopy and computer image analysis. Based on LVWT, the cases were divided into four degrees, from I to IV. The EHT, CHD, and EHT with CHD groups all rated LVWT I-IV, and the control group rated LVWT I. SAS software was used for statistical analysis.
Results:
With the aggravation of LVWT, both AD and RWL increased while CD decreased significantly in the EHT group (P < 0.05 - 0.0001); there were similar but more severe changes in the EHT with CHD group (P < 0.001 - 0.0001); and AD increased (P < 0.001) while RWL and CD did not change significantly in the CHD group.
Conclusion:
Comparing EHT with CHD patients, there are similar patterns of change to AD, but different patterns of change to RWL and CD. CML is much more severe in EHT patients with CHD. We conclude that CML is one of the main causes of decreased coronary flow reserve and myocardial damage in both EHT patients and EHT patients with CHD.
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