Alberto Foà1, Valentina Agostini2, Claudio Rapezzi3, Iacopo Olivotto4, Barbara Corti2, Luciano Potena5, Elena Biagini1, Sofia Martin Suarez5, Matteo Rotellini6, Franco Cecchi6, Pierluigi Stefano6, Raffaele Coppini7, Cecilia Ferrantini6, Maria L Bacchi Reggiani1, Ornella Leone2. 1. Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy. 2. Cardiovascular Pathology Unit, Department of Pathology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy. 3. Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Bologna, Italy. Electronic address: claudio.rapezzi@unibo.it. 4. Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy. 5. Heart Transplant Program, Sant'Orsola-Malpighi University Hospital, Bologna, Italy. 6. Cardiothoracic and Vascular Department, Careggi University Hospital, Florence, Italy. 7. Department NeuroFarBa, University of Florence, Florence, Italy.
Abstract
BACKGROUND: Although imaging techniques have demonstrated the existence of microvascular abnormalities in hypertrophic cardiomyopathy (HCM), a detailed histopathological assessment is lacking as well as a comparison between different phases of the disease. We aimed to compare microvasculopathy and myocardial fibrosis in hypertrophic obstructive cardiomyopathy (HOCM) versus end-stage (ES) HCM. METHODS: 27 myectomy specimens of HOCM patients and 30 ES-HCM explanted hearts were analyzed. Myocardial fibrosis was quantitatively determined with dedicated software and qualitatively classified as scar-like or interstitial. Intramural coronary arteries were evaluated separately according to lumen diameter: 100-500 μ versus <100 μ. Microvasculopathy assessment included the description of medial and intimal abnormalities and stenosis grading. The two subgroups were compared considering only the anterobasal septum of ES explanted hearts. RESULTS: Median value of fibrosis in the anterobasal septum of explanted hearts was 34.6% as opposed to 10.3% of myectomy specimens (p < 0.001). Scar-like fibrosis was widely found in ES hearts while interstitial fibrosis was distinctive of HOCM (p < 0.001). All slides showed 100-500 μ microvasculopathy without any differences between subgroups in terms of lumen narrowing, extent of the disease and type of parietal involvement. Among ES hearts these lesions were associated with scar-like fibrosis (p = 0.034). <100-μ microvasculopathy was also frequent with no differences between subgroups. CONCLUSIONS: Microvasculopathy is an intrinsic feature of HCM with similar characteristics across the natural phases of the disease. Conversely, myocardial fibrosis changes over time with ES hearts showing a three-fold greater amount, mainly scar-like. ES showed a closer association between microvasculopathy and replacement fibrosis.
BACKGROUND: Although imaging techniques have demonstrated the existence of microvascular abnormalities in hypertrophic cardiomyopathy (HCM), a detailed histopathological assessment is lacking as well as a comparison between different phases of the disease. We aimed to compare microvasculopathy and myocardial fibrosis in hypertrophic obstructive cardiomyopathy (HOCM) versus end-stage (ES) HCM. METHODS: 27 myectomy specimens of HOCM patients and 30 ES-HCM explanted hearts were analyzed. Myocardial fibrosis was quantitatively determined with dedicated software and qualitatively classified as scar-like or interstitial. Intramural coronary arteries were evaluated separately according to lumen diameter: 100-500 μ versus <100 μ. Microvasculopathy assessment included the description of medial and intimal abnormalities and stenosis grading. The two subgroups were compared considering only the anterobasal septum of ES explanted hearts. RESULTS: Median value of fibrosis in the anterobasal septum of explanted hearts was 34.6% as opposed to 10.3% of myectomy specimens (p < 0.001). Scar-like fibrosis was widely found in ES hearts while interstitial fibrosis was distinctive of HOCM (p < 0.001). All slides showed 100-500 μ microvasculopathy without any differences between subgroups in terms of lumen narrowing, extent of the disease and type of parietal involvement. Among ES hearts these lesions were associated with scar-like fibrosis (p = 0.034). <100-μ microvasculopathy was also frequent with no differences between subgroups. CONCLUSIONS: Microvasculopathy is an intrinsic feature of HCM with similar characteristics across the natural phases of the disease. Conversely, myocardial fibrosis changes over time with ES hearts showing a three-fold greater amount, mainly scar-like. ES showed a closer association between microvasculopathy and replacement fibrosis.
Authors: C Pandozi; Marco Valerio Mariani; C Chimenti; V Maestrini; D Filomena; M Magnocavallo; M Straito; A Piro; M Russo; M Galeazzi; S Ficili; F Colivicchi; P Severino; M Mancone; F Fedele; C Lavalle Journal: J Interv Card Electrophysiol Date: 2022-01-24 Impact factor: 1.900
Authors: Sílvia Aguiar Rosa; Boban Thomas; António Fiarresga; Ana Luísa Papoila; Marta Alves; Ricardo Pereira; Gonçalo Branco; Inês Cruz; Pedro Rio; Luis Baquero; Rui Cruz Ferreira; Miguel Mota Carmo; Luís Rocha Lopes Journal: Front Cardiovasc Med Date: 2021-12-17