Morphological and molecular condition indicators of myocardium: outcomes prediction of surgical treatment in patients with ischemic cardiomyopathy
Abstract Relevance. Ischemic cardiomyopathy is a common disease of the cardiovascular system with ambiguous postoperative outcomes. The ability to predict adverse outcomes in the pre- or intraoperative stage will help adjust tactics of surgical treatment and postoperative management of the patient.
Objective. The aim is to search for morphological and molecular indicators of myocardial condition forecasting early postoperative mortality and adverse long-term results of surgical treatment of patients with ischemic cardiomyopathy.
Materials and methods. The objects of the study were myocardium (36) and venous blood (77) of ischemic cardiomyopathy patients of both sexes with antero-apical aneurysms who were treated in the Department of Cardiovascular Surgery of the Research Institute for Сardiology from 2009 to 2013. The patients were divided into 3 groups: group 1 with unchanged or reduced ejection fraction (EF) one year after, group 2 with increased EF one year after, group 3 with the patients who died in the early postoperative period. We used histological, morphometric, immunohistochemical, biochemical and statistical methods. The research is prospective in nature, the level of evidence is II.
Results. The capillary diameter in the normokinetic segments of the myocardium was less in group 1 (4.658±0.531) compared to group 2 (5.605±0.588). In the group 2 hypokinetic segments of the myocardium the specific volume (SV) of the interstitial edema was higher than in group 3 and reached 0.039 (0.024–0.078) and 0.017 (0.012–0.023), respectively. In the akinetic zone of the left ventricular (LV) myocardium the specific volume (SV) of the stromal cell nuclei was more in group 1 (0.019 ±0.009) than in group 2 (0.010±0.007). The SV of parenchyma and cardiomyocyte diameter in the dyskinetic zone were increased in group 1, accounting for 0.620±0.059 and 23.0 (23.9–27.2), respectively, compared with group 3: 0.481±0.130 and 19.2 (18.6–20.8). The right atrial appendage (RAA) myocardial morphometry showed that the SV of the stromal cell nuclei was lower in group 1: 0.021 (0.015–0.033) compared with group 2: 0.012 (0.006–0.017). However, nuclear-cytoplasmic ratio of cardiomyocytes in group 1 was higher (0.062±0.022) than in the third group of patients (0.042±0.010). Trophic index was higher in group 2 (0.137±0.047) compared to the third group (0.093±0.039). The concentrations of MMP-3 and MMP-9 were different in the 1st and 2nd groups in blood: in group 1: 5.70 (5.16–7.05) and 455.8 (426–502.6) ng/ml; in group 2: 7.11 (6.25–8.49) and 480.8 (447.4–512.4) ng/ml, respectively. The concentration of TGF-β in the patients of group 3 were lower (2.382±1.345) than in the patients of group 1 (10.253±6.036) and group 2 (10.035±6.253).
Conclusions. Both evaluation of hypo- and dyskinetic segments of the LV wall and low concentration of transforming growth factor-β in the serum can be predictive of early postoperative mortality; assessment of normal and akinetic myocardium with high concentrations of MMP-3 and MMP-9 in the blood can forecast repeated LV remodeling in the late postoperative period. Morphometric characteristics of the right atrial appendage (RAA) myocardium have the greatest predictive value for outcomes of surgical treatment of patients with ischemic cardiomyopathy.
Keywords:ischemic cardiomyopathy, myocardium, outcome prediction
Clin. Experiment. Surg. Petrovsky J. – 2015. – N 1. – Р. 5–14.
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