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Circulation. 1994;89:151-163

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Circulation, Vol 89, 151-163, Copyright © 1994 by American Heart Association


ARTICLES

Structural basis of end-stage failure in ischemic cardiomyopathy in humans

CA Beltrami, N Finato, M Rocco, GA Feruglio, C Puricelli, E Cigola, F Quaini, EH Sonnenblick, G Olivetti and P Anversa
Department of Pathology, University of Udine, Italy.

BACKGROUND: Ischemic cardiomyopathy is characterized by myocyte loss, reactive cellular hypertrophy, and ventricular scarring. However, the relative contribution of these tissue and cellular processes to late failure remains to be determined. METHODS AND RESULTS: Ten hearts were obtained from individuals undergoing cardiac transplantation as a result of chronic coronary artery disease in its terminal stage. An identical number of control hearts were collected at autopsy from patients who died from causes other than cardiovascular disease, and morphometric methodologies were applied to the analysis of the left and right ventricular myocardium. Left ventricular hypertrophy evaluated as a change in organ weight, aggregate myocyte mass, and myocyte cell volume per nucleus showed increases of 85%, 47%, and 103%, respectively. Corresponding increases in the right ventricle were 75%, 74%, and 112%. Myocyte loss, which accounted for 28% and 30% in the left and right ventricles, was responsible for the difference in the assessment of myocyte hypertrophy at the ventricular, tissue, and cellular levels. Left ventricular muscle cell hypertrophy was accomplished through a 16% and 51% increase in myocyte diameter and length, whereas right ventricular myocyte hypertrophy was the consequence of a 13% and 67% increase in these linear dimensions, respectively. Moreover, a 36% reduction in the number of myocytes included in the thickness of the left ventricular wall was found. Collagen accumulation in the form of segmental, replacement, and interstitial fibrosis comprised an average 28% and 13% of the left and right ventricular myocardia, respectively. The combination of cell loss and myocardial fibrosis, myocyte lengthening, and mural slippage of cells resulted in 4.6-fold expansion of left ventricular cavitary volume and a 56% reduction in the ventricular mass-to-chamber volume ratio. CONCLUSIONS: These results are consistent with the contention that both myocyte and collagen compartments participate in the development of decompensated eccentric ventricular hypertrophy in the cardiomyopathic heart of ischemic origin.


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Myocyte Death in the Pathological Heart
Circ. Res., February 4, 2000; 86(2): 121 - 124.
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Cardiovasc ResHome page
H. J. Oskarsson, L. Coppey, R. M. Weiss, and W.-G. Li
Antioxidants attenuate myocyte apoptosis in the remote non-infarcted myocardium following large myocardial infarction
Cardiovasc Res, February 1, 2000; 45(3): 679 - 687.
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Cardiovasc ResHome page
G. Olivetti, E. Cigola, R. Maestri, C. Lagrasta, D. Corradi, and F. Quaini
Recent advances in cardiac hypertrophy
Cardiovasc Res, January 1, 2000; 45(1): 68 - 75.
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CirculationHome page
C. Emanueli, R. Maestri, D. Corradi, R. Marchione, A. Minasi, M. G. Tozzi, M. B. Salis, S. Straino, M. C. Capogrossi, G. Olivetti, et al.
Dilated and Failing Cardiomyopathy in Bradykinin B2 Receptor Knockout Mice
Circulation, December 7, 1999; 100(23): 2359 - 2365.
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CirculationHome page
H. Lim, J. A. Fallavollita, R. Hard, C. W. Kerr, and J. M. Canty Jr
Profound Apoptosis-Mediated Regional Myocyte Loss and Compensatory Hypertrophy in Pigs With Hibernating Myocardium
Circulation, December 7, 1999; 100(23): 2380 - 2386.
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Am. J. Physiol. Heart Circ. Physiol.Home page
J. A. Fallavollita, S. Jacob, R. F. Young, and J. M. Canty Jr.
Regional alterations in SR Ca2+-ATPase, phospholamban, and HSP-70 expression in chronic hibernating myocardium
Am J Physiol Heart Circ Physiol, October 1, 1999; 277(4): H1418 - H1428.
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Am. J. Physiol. Heart Circ. Physiol.Home page
G. Filippatos, C. Leche, R. Sunga, A. Tsoukas, P. Anthopoulos, I. Joshi, A. Bifero, R. Pick, and B. D. Uhal
Expression of FAS adjacent to fibrotic foci in the failing human heart is not associated with increased apoptosis
Am J Physiol Heart Circ Physiol, August 1, 1999; 277(2): H445 - H451.
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Cardiovasc ResHome page
G. Paternostro, D. Pagano, T. Gnecchi-Ruscone, R. S Bonser, and P. G Camici
Insulin resistance in patients with cardiac hypertrophy
Cardiovasc Res, April 1, 1999; 42(1): 246 - 253.
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CirculationHome page
Y. Y. Li, A. M. Feldman, Y. Sun, and C. F. McTiernan
Differential Expression of Tissue Inhibitors of Metalloproteinases in the Failing Human Heart
Circulation, October 27, 1998; 98(17): 1728 - 1734.
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CirculationHome page
K. Nakamura, K. Fushimi, H. Kouchi, K. Mihara, M. Miyazaki, T. Ohe, and M. Namba
Inhibitory Effects of Antioxidants on Neonatal Rat Cardiac Myocyte Hypertrophy Induced by Tumor Necrosis Factor-{alpha} and Angiotensin II
Circulation, August 25, 1998; 98(8): 794 - 799.
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CirculationHome page
A. Zafeiridis, V. Jeevanandam, S. R. Houser, and K. B. Margulies
Regression of Cellular Hypertrophy After Left Ventricular Assist Device Support
Circulation, August 18, 1998; 98(7): 656 - 662.
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Circ. Res.Home page
H. F. Clemo, B. S. Stambler, and C. M. Baumgarten
Persistent Activation of a Swelling-Activated Cation Current in Ventricular Myocytes From Dogs With Tachycardia-Induced Congestive Heart Failure
Circ. Res., July 27, 1998; 83(2): 147 - 157.
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Proc. Natl. Acad. Sci. USAHome page
J. Kajstura, A. Leri, N. Finato, C. Di Loreto, C. A. Beltrami, and P. Anversa
Myocyte proliferation in end-stage cardiac failure in humans
PNAS, July 21, 1998; 95(15): 8801 - 8805.
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CirculationHome page
K. T. Weber
Extracellular Matrix Remodeling in Heart Failure : A Role for De Novo Angiotensin II Generation
Circulation, December 2, 1997; 96(11): 4065 - 4082.
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Cardiovasc ResHome page
K. McDonald, C. Chu, G. Francis, D. Judd, W. Carlyle, C. Toher, K. Hauer, and M. Hartman
The effect of delayed reperfusion following infarction in the rat on structural changes in viable myocardium
Cardiovasc Res, December 1, 1997; 36(3): 347 - 353.
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CirculationHome page
E. Missov, C. Calzolari, and B. Pau
Circulating Cardiac Troponin I in Severe Congestive Heart Failure
Circulation, November 4, 1997; 96(9): 2953 - 2958.
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Am. J. Physiol. Heart Circ. Physiol.Home page
B. Li, Q. Li, X. Wang, K. P. Jana, G. Redaelli, J. Kajstura, and P. Anversa
Coronary constriction impairs cardiac function and induces myocardial damage and ventricular remodeling in mice
Am J Physiol Heart Circ Physiol, November 1, 1997; 273(5): H2508 - H2519.
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NEJMHome page
G. Olivetti, R. Abbi, F. Quaini, J. Kajstura, W. Cheng, J. A. Nitahara, E. Quaini, C. Di Loreto, C. A. Beltrami, S. Krajewski, et al.
Apoptosis in the Failing Human Heart
N. Engl. J. Med., April 17, 1997; 336(16): 1131 - 1141.
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CirculationHome page
B. I. Jugdutt, M. J. Joljart, and M. I. Khan
Rate of Collagen Deposition During Healing and Ventricular Remodeling After Myocardial Infarction in Rat and Dog Models
Circulation, July 1, 1996; 94(1): 94 - 101.
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CirculationHome page
C.M. Yu, J.E. Sanderson, S. Chan, L. Yeung, Y.T. Hung, and K.S. Woo
Right Ventricular Diastolic Dysfunction in Heart Failure
Circulation, April 15, 1996; 93(8): 1509 - 1514.
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BMJHome page
D. Darbar, J. Luck, N. Davidson, T. Pringle, G. Main, G. McNeill, and A. D Struthers
Sensitivity and specificity of QTc dispersion for identification of risk of cardiac death in patients with peripheral vascular disease
BMJ, April 6, 1996; 312(7035): 874 - 878.
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CirculationHome page
C.H. Davies, K. Davia, J.G. Bennett, J.R. Pepper, P.A. Poole-Wilson, and S.E. Harding
Reduced Contraction and Altered Frequency Response of Isolated Ventricular Myocytes From Patients With Heart Failure
Circulation, November 1, 1995; 92(9): 2540 - 2549.
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CirculationHome page
J. Kajstura, X. Zhang, Y. Liu, E. Szoke, W. Cheng, G. Olivetti, T. H. Hintze, and P. Anversa
The Cellular Basis of Pacing-Induced Dilated Cardiomyopathy : Myocyte Cell Loss and Myocyte Cellular Reactive Hypertrophy
Circulation, October 15, 1995; 92(8): 2306 - 2317.
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CirculationHome page
K. M. McDonald, J. Mock, A. D'Aloia, T. Parrish, K. Hauer, G. Francis, A. Stillman, and J. N. Cohn
Bradykinin Antagonism Inhibits the Antigrowth Effect of Converting Enzyme Inhibition in the Dog Myocardium After Discrete Transmural Myocardial Necrosis
Circulation, April 1, 1995; 91(7): 2043 - 2048.
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Proc. Natl. Acad. Sci. USAHome page
D. Orlic, J. Kajstura, S. Chimenti, F. Limana, I. Jakoniuk, F. Quaini, B. Nadal-Ginard, D. M. Bodine, A. Leri, and P. Anversa
Mobilized bone marrow cells repair the infarcted heart, improving function and survival
PNAS, August 28, 2001; 98(18): 10344 - 10349.
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Am. J. Physiol. Heart Circ. Physiol.Home page
J. A. Fallavollita and J. M. Canty Jr.
Ischemic cardiomyopathy in pigs with two-vessel occlusion and viable, chronically dysfunctional myocardium
Am J Physiol Heart Circ Physiol, April 1, 2002; 282(4): H1370 - H1379.
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Am. J. Physiol. Heart Circ. Physiol.Home page
Y. Takimoto, T. Aoyama, Y. Iwanaga, T. Izumi, Y. Kihara, D. Pennica, and S. Sasayama
Increased expression of cardiotrophin-1 during ventricular remodeling in hypertensive rats
Am J Physiol Heart Circ Physiol, March 1, 2002; 282(3): H896 - H901.
[Abstract] [Full Text] [PDF]