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Vulnerable myocardial interstitium in patients with isolated left ventricular hypertrophy and sudden cardiac death: a

Balaji K Tamarappoo1, Benjamin T John, Kyndaron Reinier

  • 1Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (B.K.T., B.T.J., K.R., C.T., A.U.-E., S.S.C.) ; Cleveland Clinic Foundation, Cleveland OH (B.K.T.).

Journal of the American Heart Association
|November 7, 2012
PubMed

Insights

Sudden cardiac death in patients with isolated left ventricular hypertrophy (LVH) is linked to increased collagen volume and a higher proportion of type III collagen in the heart. These findings suggest a potential mechanism for increased arrhythmia vulnerability in LVH patients.

Area of Science:

  • Cardiology
  • Pathology
  • Biomedical Engineering

Background:

  • Concentric left ventricular hypertrophy (LVH) is a known risk factor for sudden cardiac death (SCD).
  • Alterations in the myocardial interstitium in animal models of LVH may increase susceptibility to ventricular arrhythmias.
  • Human studies are needed to evaluate these interstitial changes in LVH patients who experience SCD.

Purpose of the Study:

  • To investigate myocardial interstitial differences in patients with isolated LVH and SCD.
  • To compare collagen content, collagen subtypes, and gap junction alterations in LVH+SCD cases versus controls.
  • To identify potential structural factors contributing to SCD in LVH.

Main Methods:

  • Postmortem analysis of myocardial tissue from 12 LVH+SCD patients and 34 controls (18 with LVH, 16 with normal hearts).
  • Measurement of heart weight, collagen volume fraction, and collagen type III percentage.
  • Quantification of connexin 43-labeled gap junctions.

Main Results:

  • LVH+SCD cases had significantly higher normalized heart weight and collagen volume fraction compared to both control groups.
  • A significantly higher relative amount of type III collagen was observed in LVH+SCD cases.
  • Increased connexin 43-labeled gap junctions correlated with larger myocyte size.

Conclusions:

  • SCD in isolated LVH is associated with increased myocardial mass and overall collagen.
  • A relative abundance of type III collagen is a novel finding in LVH with SCD.
  • Further research is warranted to understand the mechanistic role of type III collagen in SCD associated with LVH.
Abstract

Keywords:
collagendeath, suddenhypertrophymyocardiumremodeling

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