MORPHOMETRIC MARKERS IN ENDOMYOCARDIAL BIOPSIES

FAVALORO L; DIEZ M; CORTES C; SANCHEZ D; VIGLIANO C; CABEZA MECKERT P; LAGUENS R; PERRONE SV

Viena

Congreso; Congress of the European Society of Cardiology; 2003

European Society of Cardiology

Introduction: Previous studies suggest that morphometric markers inrightventricular endomyocardial biopsies (EMB) of patients with non-ischemicdilatedcardiomyopathy (NIDCM) and severely depressed left ventricular (LV)ejection fraction (EF) have significant prognostic value. Our aim was toestablishif the EMB morphometric analysis data of patients with NIDCM receivingcurrent medical treatments for heart failure correlate with survival.Methods: EMBs from 110 patients with NIDCM were analysed. Mean age was44.62±14 years; 73 (66%) were males; 67% were in New YorkHeart Association(NYHA) class III-IV; mean LVEF was 22.4±7.9% and mean left ventricularend-diastolic diameter (LVEDD) was 70.8±10.7 mm. Etiology: 32% were idiopathic;26%, hypertensive; 11%, myocarditis; 10%, alcohol/toxic; 7%, peripartum;5%, diabetic; 5%, Chagas? disease; and 4%, other. Medical treatment was:81%, angiotensin-converting enzyme inhibitor; 9%, angiotensinII-receptor antagonist;81%, digoxin; 81%, furosemide; 52% spironolactone; 25%, beta blockers;41%, amiodarone; and 44%, oral anticoagulation. Cardiomyocyte diameter(CMD), interstitial fibrosis and cell replication markers (Ki 67 inmyocyte nucleiand Ki 67 in interstitial cells) were assessed. Morphometric, clinical,hemodynamicand echocardiographic variables were analysed in relation to survival bythe Kaplan-Meier method. Cox multivariate regression analysis wasperformed.Results: Mean follow-up was 2.72±2 years.End-point combining mortalityand urgent transplant was 33% (28 patients died and 8 underwent urgenttransplantation). Mean CMD was 17.68±2.6 ìm. Survival analysis showedthat CMD >17.68 ìm was stronglyassociated with death or urgent transplantduring follow-up (log rank test 11.29, P<.0008). Ten of the 57 patientswith CMD <17.68 ìm and 26 of the53 patients with CMD >17.68 ìm died.Other variables correlating with death or urgent transplant were: meanpulmonaryartery pressure (MPAP) >23.2 mmHg (9.88, P<.0017); LVEDD >70.7mm (6.1, P<.01), NYHA class III-IV (9.31, P<.002); cardiacindex <2.9 l/min-1/m-2 (6.79, P<.009). LVEF, amount of fibrosis and Ki 67 did notcorrelatewith survival. On multivariate analysis, CMD (Wald= 4.92, P<.02), MPAP (6.38,P<.011) and LVEDD (4.09, P<.04) were predictors of mortality.Conclusion: EMB myocyte hypertrophy degree in patients with NIDCMis anindependent predictor of mortality in spite of neurohumoral blockers inthe treatmentof heart failure. Fibrosis amount and cell replication markers did notcorrelatewith survival. MPAP and LVEDD are also independent predictors ofmortality.