Avtor/Urednik     Segura, Ana Maria; Radovančević, Rajko; Aguayo, Alberto; Frazier, O.H.; Buja, L. Maximilian
Naslov     Variability in fibrosis in tissue samples obtained during diaphragmatic and apical LVAD implantation
Tip     članek
Leto izdaje     2014
ISSN     1054-8807 - Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology
Jezik     eng
Abstrakt     Background Histopathologic study of left ventricular (LV) tissue can provide structural data on the heart at the time of left ventricular assist device (LVAD) implantation. We assessed the effect of cannula placement site (apical/diaphragmatic) and cardiomyopathy etiology (ischemic/nonischemic) on cardiac histopathologic changes. Methods In 77 heart failure patients, tissue was obtained from the standard apical cannula insertion site or the diaphragmatic surface site during implantation of the HeartMate II (n=53) or HeartWare (n=24) LVAD. Fibrosis and hypertrophy (cytoplasmic and nuclear diameter) were evaluated by computerized morphometry. Results Thirty-two patients (27 men, 5 women; age, 57+-15 years) underwent diaphragmatic implantation, and 45 (32 men, 13 women; age, 53+-12 years) underwent apical implantation. The incidence of ischemic cardiomyopathy in the diaphragmatic and apical groups was 11/32 (34%) vs. 25/45 (56%) (P=.104). Overall, diaphragmatic tissue had less fibrosis than apical tissue (15.7+-11.7% vs. 22.0+-17.4%, P=.033), but both showed similar hypertrophic changes (cytoplasmic diameter, 39.0+-10.3microm vs. 36.3+-8.7microm, P=.141; nuclear diameter, 15.5+-2.5microm vs. 14.8+-3.0microm, P=.171). Likewise, in ischemic cardiomyopathy, apical samples showed more fibrosis than diaphragmatic samples (26.54+-19.0% vs. 15.86+-11.08%, P=.046) but similar hypertrophic changes (cytoplasmic diameter, 34.95+-6.12microm vs. 37.48+-12.07microm, P=.288; nuclear diameter, 14.66+-2.69microm vs. 14.78+-1.31microm, P=.451). Conclusion Myocardial histology results at the time of LVAD placement and their prognostic implications may be affected by inlet placement site and cardiomyopathy etiology. In this study, LV samples from apical implantation in ischemic cardiomyopathy patients were the most fibrotic. Thus, sampling site and cardiomyopathy etiology should be considered when interpreting LV samples obtained during LVAD implantation.
Proste vsebinske oznake     fibrosis
hypertrophy
devices
fibroza
hipertrofija
naprave