دورية أكاديمية
Subendocardial "ischemic-like" state in patients with severe aortic stenosis: Insights from myocardial histopathology and ultrastructure.
| العنوان: | Subendocardial "ischemic-like" state in patients with severe aortic stenosis: Insights from myocardial histopathology and ultrastructure. |
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| المؤلفون: | Abecasis J; Cardiology Department, Hospital de Santa Cruz, Lisboa, Portugal; Nova Medical School, Lisboa, Portugal. Electronic address: joaoabecasis@hotmail.com., Maltês S; Cardiology Department, Hospital de Santa Cruz, Lisboa, Portugal., Santos RR; Cardiology Department, Hospital de Santa Cruz, Lisboa, Portugal., Lopes P; Cardiology Department, Hospital de Santa Cruz, Lisboa, Portugal., Manso RT; Pathology Department, Hospital de Santa Cruz, Lisboa, Portugal., Gil V; Hospital da Luz, Lisboa, Portugal; Faculdade de Medicina, Universidade Católica, Lisboa, Portugal., Cardim N; Nova Medical School, Lisboa, Portugal., Ramos S; Pathology Department, Hospital de Santa Cruz, Lisboa, Portugal., Félix A; Nova Medical School, Lisboa, Portugal; Pathology Department, IPOFG, Lisboa, Portugal. |
| المصدر: | Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology [Cardiovasc Pathol] 2024 Mar-Apr; Vol. 69, pp. 107589. Date of Electronic Publication: 2023 Nov 28. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Science Pub. Co Country of Publication: United States NLM ID: 9212060 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-1336 (Electronic) Linking ISSN: 10548807 NLM ISO Abbreviation: Cardiovasc Pathol Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: New York, NY : Elsevier Science Pub. Co., c1992- |
| مواضيع طبية MeSH: | Aortic Valve Stenosis*/surgery , Heart Defects, Congenital*/pathology , Cardiomyopathies*/pathology , Heart Valve Prosthesis Implantation*, Humans ; Female ; Male ; Myocardium/pathology ; Fibrosis ; Ischemia ; Ventricular Function, Left |
| مستخلص: | Background: Myocardial adaptation to severe aortic stenosis (AS) is a complex process that involves myocardial fibrosis (MF) beyond cardiomyocyte hypertrophy. Perfusion impairment is believed to be involved in myocardial remodeling in chronic pressure overload. Aim: To describe morphological and ultrastructural myocardial changes at endomyocardial tissue sampling, possibly reflecting subendocardial ischemia, in a group of patients with severe AS referred to surgical aortic valve replacement (AVR), with no previous history of ischemic cardiomyopathy. Methods: One-hundred-fifty-eight patients (73 [68-77] years, 50% women) referred for surgical AVR because of severe symptomatic AS with preoperative clinical and imaging study and no previous history of ischemic cardiomyopathy. Intra-operative septal endomyocardial sampling was obtained in 129 patients. Tissue sections were stained with Masson´s Trichrome for MF quantification and periodic acid-Schiff (PAS) staining was performed to assess the presence of intracellular glycogen. Ultrastructure was analyzed through Transmission electron microscopy (TEM). Results: MF totalized a median fraction of 11.90% (6.54-19.97%) of EMB, with highly prevalent perivascular involvement (95.3%). None of the samples had histological evidence of myocardial infarction. In 58 patients (45%) we found subendocardial groups of cardiomyocytes with cytoplasmatic enlargement, vacuolization and myofiber derangement, surrounded by extensive interstitial fibrosis. These cardiomyocytes were PAS positive, PAS-diastase resistant and Alcian Blue/PAS indicative of the presence of neutral intracellular glyco-saccharides. At TEM there were signs of cardiomyocyte degeneration with sarcomere disorganization and reduction, organelle rarefaction but no signs of intracellular specific accumulation. Conclusion: Almost half of the patients with severe AS referred for surgical AVR have histological and ultrastructural signs of subendocardial cardiomyocyte ischemic insult. It might be inferred that local perfusion imbalance contributes to myocardial remodeling and fibrosis in chronic pressure overload. Competing Interests: Declaration of Competing Interest None to declare (on behalf of all authors) (Copyright © 2023 Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: Aortic stenosis; Electron microscopy; Endomyocardial sampling; Histopathology; Myocardial ischemia |
| تواريخ الأحداث: | Date Created: 20231129 Date Completed: 20240223 Latest Revision: 20240223 |
| رمز التحديث: | 20240223 |
| DOI: | 10.1016/j.carpath.2023.107589 |
| PMID: | 38029890 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1879-1336 |
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| DOI: | 10.1016/j.carpath.2023.107589 |