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Myofibrillolysis and fibrosis predicts myocardial insufficiency

Jerzy Pacholewicz1, Michał Zakliczyński1, Jerzy Nożyński1

  • 1Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases in Zabrze, Poland.

Kardiochirurgia I Torakochirurgia Polska = Polish Journal of Cardio-Thoracic Surgery
|August 15, 2019
PubMed

Insights

Cardiomyopathy progression, including fibrosis, is driven by the loss of heart muscle cells (cardiomyocytes), not their degeneration. This impacts left ventricular assist device (LVAD) patient outcomes.

Area of Science:

  • Cardiovascular Pathology
  • Cardiac Surgery
  • Histopathology

Background:

  • Cardiomyopathies involve histopathological changes like cardiocyte myofibrillolysis and interstitial fibrosis, contributing to heart failure.
  • These changes are critical in understanding disease progression and treatment efficacy.

Purpose of the Study:

  • To evaluate histopathological changes, specifically fibrosis and myofibrillolysis, in myocardial tissue resected during left ventricular assist device (LVAD) implantation.
  • To compare these changes in patients with cardiomyopathy (CM/VAD group) against a control group of healthy heart donors.

Main Methods:

  • Analysis of apical myocardial samples from 40 patients with cardiomyopathy undergoing LVAD implantation (CM/VAD group) and 6 healthy heart donors (control group).
  • Quantification of area fraction (AF) for fibrosis, cardiocytes with myofibrillolysis (MFL), and non-myofibrillolytic cardiocytes (non-MFL).
  • Semiquantitative evaluation of cardiomyopathy grade and correlation analysis between fibrosis and cardiomyocyte types.

Main Results:

  • The CM/VAD group exhibited significantly higher fibrosis (nearly 10x) and MFL cell area (nearly 5x) compared to the control group.
  • A strong negative correlation was observed between fibrosis progression and the presence of normal cardiomyocytes, indicating cardiomyocyte loss.
  • Cardiomyopathy was graded as slight, moderate, or advanced, with lymphocyte presence noted in 45% of CM/VAD cases.

Conclusions:

  • Cardiomyopathy and fibrosis progression are primarily associated with the depletion of cardiomyocytes.
  • The findings suggest that the loss of functional heart muscle cells, rather than cellular degeneration, is the key driver in advanced cardiomyopathy.
  • Understanding these mechanisms is crucial for managing heart failure and optimizing LVAD therapy.
Abstract

Keywords:
cardiomyopathymyofibrillolysissarcoplasm

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