Circulation, Vol 82, 1387-1401, Copyright © 1990 by American Heart Association
KT Weber, R Pick, MA Silver, GW Moe, JS Janicki, IH Zucker and PW Armstrong
To test the hypothesis that in the failing volume-overloaded ventricle, the
extracellular matrix and fibrillar collagen in particular are major
determinants of the architectural remodeling of the myocardium, this
histopathological study of the dilated, postmortem canine left ventricle
secondary to rapid ventricular pacing or aortocaval fistula was undertaken.
Using the picrosirius-polarization technique to enhance collagen
birefringence, we sought to examine the structural integrity of the
collagen matrix and interstitium. In the dilated failing ventricle
secondary to rapid pacing, we found 1) interstitial edema and a disruption
or disappearance of collagen fibers that were apparent within 6 hours of
pacing, persisted for weeks, and subsequently were associated with muscle
fiber disorganization within the endomyocardium, 2) interstitial fibrosis
that was present in the midwall and epimyocardium with chronic pacing, and
3) an early remodeling of intramyocardial coronary arteries that included
medial swelling with smooth muscle degeneration followed by proliferative
lesions involving fibroblasts and a subsequent perivascular and medial
fibrosis. Many of these findings were still evident 48 hours after pacing
had been discontinued. In contrast, the collagen matrix and interstitium
seen with ventricular dilatation secondary to the circulatory overload that
accompanies an aortocaval fistula were indistinguishable from that in
sham-operated controls. Thus, we conclude that unlike the chamber
enlargement and preserved ventricular function that accompany an aortocaval
fistula, ventricular dilatation and failure caused by rapid pacing are
based on an architectural remodeling of the myocardium. This structural
dilatation involves the extracellular matrix and interstitium and appears
to be related to altered permeability of intramyocardial coronary arteries.
The mechanism or mechanisms involved in the pathogenesis of myocardial
remodeling with rapid ventricular pacing require further investigation.
ARTICLES
Fibrillar collagen and remodeling of dilated canine left ventricle
Cardiovascular Institute, Michael Reese Hospital, University of Chicago Pritzker School of Medicine.
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