Clinical Variables Associated With the Presence of Inflammatory Infiltrates in Patients With Dilated Cardiomyopathy Undergoing Heart Transplantation

• Published in: Transplantation proceedings Vol. 40; no. 9; pp. 3017 - 3019
• Main Authors: Agüero, J, Navarro, J, Medina, M.C, Almenar, L, Chirivella, M, Martínez-Dolz, L, Moro, J.A, Sánchez-Lazaro, I, Ortiz, V, Raso, R, Salvador, A
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Inc 01.11.2008; Elsevier
• Subjects: Adult; Biological and medical sciences; Biopsy; Cardiology. Vascular system; Cardiomyopathy, Dilated - diagnostic imaging; Cardiomyopathy, Dilated - drug therapy; Cardiomyopathy, Dilated - pathology; Cardiomyopathy, Dilated - surgery; Cardiotonic Agents - therapeutic use; Dobutamine - therapeutic use; Echocardiography; Eosinophils - pathology; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Heart; Heart Transplantation - physiology; Heart Ventricles - anatomy & histology; Heart Ventricles - pathology; Humans; Inflammation - diagnostic imaging; Inflammation - pathology; Inflammation - physiopathology; Male; Medical sciences; Middle Aged; Myocarditis. Cardiomyopathies; Myocardium - pathology; Retrospective Studies; Sex Characteristics; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology; Heart; Human; Cardiovascular disease; Patient; Inflammation; Transplantation; Homotransplantation; Myocardial disease; Medicine; Infiltrate; Association; Treatment; Congestive hypertrophic cardiomyopathy; Surveillance; Dilated cardiomyopathy; Heart disease; Surgery; Clinical biology; Graft; Clinical investigation; Circulatory system
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2008.09.010

Abstract Introduction Idiopathic dilated cardiomyopathy (DCM) is, together with ischemic heart disease, the major cause of end-stage heart failure leading to heart transplantation. However, an unknown percentage of patients with this diagnosis has inflammatory foci found in the histopathological study of the explanted heart. This fact suggests an undetected process of acute myocarditis as the cause of cardiac dysfunction. Objective The objective of this study was to identify clinical and echocardiographic variables related to the presence of myocardial infiltrates, as a potential guide to determine which patients should undergo endomyocardial biopsy in DCM. Materials and Methods We retrospectively analyzed 161 patients who underwent heart transplantation with a diagnosis of DCM between 1987 and 2007. The presence of inflammatory infiltrates was considered significant when the histopathological study of tissue blocks from the left ventricle showed 1 or more foci per cm2 of perivascular or interstitial mononuclear or polymorphonuclear cells, whether or not in the presence of cytolysis. Results Seventeen patients (11%) had these inflammatory histological findings; of them, 6 (35%) showed preponderance of eosinophils and 7 (41%) showed areas of cytolysis. The DCM group with inflammatory infiltrates showed significant differences in terms of younger age (45 ± 15 vs 50 ± 11 years; P < .01) and smaller ventricular diameters ( P < .05). Male gender was more frequent in this group, and the patients had a poorer clinical status and greater dependence on inotropic drugs. Conclusions Inflammatory infiltrates are frequently present in DCM explanted hearts. Although there are no relevant clinical variables to identify subclinical myocarditis, these patients are younger and have smaller ventricular diameters and poorer functional status at the time of transplantation.