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Small vessel disease (SVD) in patients with unexplained ventricular arrhythmia and dilated congestive cardiomyopathy
P Tanganelli1, C Pierli, A Bravi
1Department of Cardiology, University of Siena, Italy.
Insights
Small vessel coronary disease is rare in nondiabetic patients with heart failure or arrhythmia. However, four patients showed this condition and thickened heart vessels, suggesting a potential cause for their heart issues.
Area of Science:
- Cardiology
- Pathology
Background:
- Small vessel coronary disease is infrequently diagnosed via endomyocardial biopsies (EMB) in nondiabetic individuals presenting with ischemic heart disease, congestive heart failure, or ventricular arrhythmia (VA).
- Identifying the underlying causes of heart failure and ventricular arrhythmias is crucial for effective patient management.
Purpose of the Study:
- To investigate the prevalence and histological characteristics of small vessel coronary disease in nondiabetic patients with unexplained heart failure or ventricular arrhythmias.
Main Methods:
- A cohort of 166 patients with clinical evidence of ischemic heart disease, congestive heart failure, or ventricular arrhythmia underwent heart catheterization and multiple right ventricle EMB.
- Histological and ultrastructural examinations were performed on EMB samples to identify specific vascular and cellular changes.
Main Results:
- Four out of 166 patients (approximately 2.4%) exhibited histologic evidence of small vessel disease despite normal coronary arteriograms.
- These four patients presented with either ventricular arrhythmia or congestive heart failure, with dilated cardiac chambers and impaired left ventricular function.
- Histologic examination revealed thickened precapillary arterioles and capillary vessels, with significant subendothelial lamina and capillary pericyte basement membrane thickening.
- Ultrastructural analysis confirmed a four- to five-fold increase in the thickening of these vascular components.
- Degenerative changes in cardiac myocytes were observed in all four affected patients.
Conclusions:
- Small vessel coronary disease, characterized by arteriolar and capillary wall thickening, can occur in nondiabetic patients with heart failure or ventricular arrhythmias, even with normal coronary arteriograms.
- This finding suggests that small vessel disease may be an underrecognized cause of heart dysfunction and arrhythmias in specific patient populations.
- Further research is warranted to elucidate the pathogenesis and clinical implications of this condition.
Abstract:
Small vessel coronary disease is not commonly found in endomyocardial biopsies (EMB) of nondiabetic patients with clinical evidence of ischemic heart disease, congestive heart failure, or ventricular arrhythmia (VA). In 166 patients studied by heart catheterization and multiple right ventricle EMB, we identified 4 patients with histologic evidence of small vessel disease and normal coronary arteriograms. Two patients were suffering from VA without an obvious cardiac cause. Of the other two, one initially showed frequent ventricular tachycardia attacks followed by congestive heart failure alone. In both patients, the cardiac chambers were dilated and the left ventricular function seriously impaired. In all four patients, the histologic examination of right EMB revealed a wall thickening of the precapillary arterioles and capillary vessels. At ultrastructural examination, an increased thickening (four or five times normal) of the subendothelial lamina and of the basement membrane of capillary pericytes was found. Degenerative changes of cardiac myocells were found in all cases.