Endomyocardial biopsy: survival markers in dilated non-coronary cardiomyopathy

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Abstract

Study objective: To establish whether the endomyocardial biopsy morphometric analysis data of patients with non-ischemic dilated cardiomyopathy correlate with urgent or emergent-trans-plant-free survival rate and with functional, haemodynamic and echocardiographic parameters.

Research design and methods: Endomyocardial biopsies from 110 patients with congestive heart failure secondary to non-ischemic dilated cardiomyopathy defined as <40% left ventricular ejection fraction and no significant coronary lesions were retrospectively analysed. Cardiomyocyte diameter, interstitial fibrosis and cell replication markers (Ki 67 in myocyte nuclei and Ki 67in interstitial cells) were assessed. Endpoint was defined as the combination of mortality and urgent or emergent trans-plant.

Results: Mean age was 44.62±14 years; 66% were male; 67% wereNew York Heart Association class III-IV; mean left ventricular ejection fraction was 22.4±7.9% and mean left ventricular end-diastolic diameter was 70.8 ± 10.7mm. Mean follow-up was 2.72±2 years. The combined endpoint was 33%.The survival analysis showed that a cardiomyocyte diameter of 17.68 μm (log rank test 11.29, p<.001) had a strong correlation with the endpoint. On multivariate analysis, cardiomyocyte diameter with a relative risk of 1.22 (95%confidence interval, 1.027-1.449) was an independent predictor of mortality and urgent transplant. There was a weak positive association between cardiomyocyte diameter and ventricular diameters and pulmonary artery pressure. Fibrosis and Ki 67 did not correlate with the endpoint.

Conclusion: The degree of myocyte hypertrophy is an independent predictor of mortality and urgent transplant. Fibrosis and Ki67 did not correlate with the endpoint.