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[Morphologic findings in dilated cardiomyopathy and their relation to hemodynamics and catecholamine concentrations
J Schofer1, C Bartels, D Hölscher
1Abteilung Kardiologie, Universitäts-Krankenhaus Hamburg-Eppendorf.
Insights
Dilated cardiomyopathy involves structural changes and altered catecholamine levels. Differentiating severely reduced ventricular function is best achieved by assessing plasma catecholamines, muscle fiber diameter, and capillary density.
Area of Science:
- Cardiology
- Pathology
- Biochemistry
Context:
- Dilated cardiomyopathy (DCM) is a significant cause of heart failure.
- Morphological and biochemical alterations characterize DCM progression.
- Understanding these changes is crucial for diagnosis and management.
Purpose:
- To investigate the relationship between morphological alterations in dilated cardiomyopathy and clinical parameters.
- To correlate transvenous endomyocardial biopsy findings with left ventricular ejection fraction and catecholamine levels.
- To identify key indicators for differentiating severely reduced ventricular function in DCM patients.
Summary:
- Morphological alterations, including muscle fiber diameter, were studied in 72 DCM patients via endomyocardial biopsy.
- Muscle fiber diameter showed negative correlations with ejection fraction and mitochondrial volume.
- Plasma norepinephrine negatively correlated with ejection fraction, while myocardial norepinephrine positively correlated.
- Myocardial norepinephrine also negatively correlated with muscle fiber diameter.
- A multi-variant analysis incorporating muscle fiber diameter, plasma norepinephrine, and capillary density accurately differentiated patients with ejection fractions <30% and >45% (79% accuracy).
Impact:
- Morphological and catecholamine alterations are integral to dilated cardiomyopathy.
- Combined assessment of plasma catecholamines, muscle fiber diameter, and capillary density offers a promising method for identifying patients with severely reduced ventricular function.
- This approach may enhance diagnostic accuracy and inform treatment strategies for DCM.
Abstract:
In 72 patients with dilated cardiomyopathy the degree of morphological alterations were studied by transvenous endomyocardial biopsy. These findings were correlated to the clinical status, left ventricular ejection fraction, and to the catecholamine concentrations in plasma and myocardium. Muscle fiber diameter was negatively correlated to ejection fraction (r = -0.3, p = 0.02) and to the volume fraction of mitochondria (r = -0.32, p = 0.001). Between plasma norepinephrine concentration and ejection fraction a significant negative correlation was found (r = -0.37, p = 0.001). In contrast, myocardial norepinephrine concentration was positively correlated to ejection fraction (r = 0.25, p = 0.04). Between myocardial norepinephrine concentration and muscle fiber diameter a negative correlation was found (r = -0.46, p = 0.004). Patients with an EF of less than 30% and an EF of greater than 45% could be differentiated with an accuracy of 79%, when muscle fiber diameter, plasma norepinephrine concentration, and the density of capillary vessels were entered into a multi-variant analysis. In conclusion, dilated cardiomyopathy is associated with morphological alterations and alterations in plasma and myocardial catecholamine concentrations. Patients with highly reduced ventricular function could be best identified by the combined assessment of plasma catecholamine concentration, muscle fiber diameter, and density of capillary vessels.