Clinical impact of the pathological quantification of myocardial fibrosis and infiltrating T lymphocytes using an endomyocardial biopsy in patients with hypertrophic cardiomyopathy. (1st September 2022)

• Record Type: Journal Article
• Authors: Shintani, Yasuhiro; Nakayama, Takafumi; Masaki, Ayako; Yokoi, Masashi; Wakami, Kazuaki; Ito, Tsuyoshi; Goto, Toshihiko; Sugiura, Tomonori; Inagaki, Hiroshi; Seo, Yoshihiro
• Is Part Of: International journal of cardiology. Volume 362(2022)
• Page Start: 110
• Page End: 117
• Publication Date: 2022-09-01
• Subjects: Hypertrophic cardiomyopathy -- Endomyocardial biopsy -- Myocardial fibrosis -- Inflammatory cell -- Myocardial diameter -- Nuclear irregularity; BNP brain natriuretic peptide -- CAF collagen area fraction -- CMRI cardiac magnetic resonance imaging -- CVP central venous pressure -- ECV extracellular volume fraction -- EMB endomyocardial biopsy -- GLS global longitudinal strain -- HCM hypertrophic cardiomyopathy -- HyT2 myocardial hyperintensity upon CMRI T2-weighted short-tau inversion recovery -- ICC intraclass correlation coefficient -- IVS interventricular septal thickness -- LOA limits of agreement -- LGE late gadolinium enhancement -- LV left ventricle, left ventricular -- LVDD left ventricular diastolic diameter -- LVEF left ventricular ejection fraction -- MWT maximum wall thickness -- PWD posterior wall thickness -- RV right ventricle, right ventricular -- SCD sudden cardiac death; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.05.068
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: The impact of quantitative pathological findings derived from endomyocardial biopsies (EMB) on clinical prognosis in patients with hypertrophic cardiomyopathy (HCM) remains unclear. Methods: We retrospectively studied 55 consecutive HCM patients who underwent EMB. We quantified the collagen area fraction (CAF), the cardiomyocyte diameter, the nuclear area and circularity, and the number of myocardial infiltrating CD3 + cells using EMB samples by image analyzing software. The primary clinical endpoint was defined as a composite including cardiovascular death, admission due to heart failure and ventricular arrhythmia. Results: During the median follow-up of 37.2 months, the primary endpoint was found in 12 patients. No significant difference in the risk score of 5-year sudden cardiac death was observed between the event-occurrence group and the event-free group. In the multivariable Cox proportional-hazard analysis, CAF [hazard ratio (HR) per 10% increase: 1.555, 95% CI: 1.014–2.367, p = 0.044] and the number of infiltrating CD3 + cells (HR per 10% increase: 1.231, 95% CI: 1.011–1.453, p = 0.041) were the independent predictors of the primary endpoint, while the myocardial diameter and the nuclear irregularity had no significant prognostic impact. Kaplan-Meier survival curves demonstrated that patients with both higher CAF and higher number of CD3 + cells had the worst prognosis (log-rank, P < 0.001). Conclusions: The higher CAF and the higher number of infiltrating CD3 + cells quantified using EMB samples were the independent predictors of poor clinical outcomes in patients with HCM. Cardiomyocyte diameter and nuclear irregularity did not significantly impact the clinical prognosis. Highlights: The utility of the myocardial biopsy in hypertrophic cardiomyopathy remains unclear Quantified assessments were performed using endomyocardial biopsy samples The fibrosis area and the number of infiltrating T lymphocytes impacted the prognosis The myocardial diameter and the nuclear irregularity did not impact the prognosis