Die Bedeutung der endomyokardialen Katheterbiopsie für die Diagnostik und die Beurteilung der Prognose der kongestiven Kardiomyopathie

Abstract

Endomyocardial biopsies were obtained from the right ventricle in 25 patients with the clinical diagnosis of congestive cardiomyopathy. The biopsies were subjected to virological and histological studies (light and electronmicroscopy) and the findings correlated with clinical data. Abnormal morphological findings were present in all patients. The presumed clinical diagnosis was confirmed in 19, the morphological changes not being consistent with the clinical diagnosis of CCM in six patients. Electronmicroscopy revealed cardiac storage disease in one patient and pathological changes secondary to previous myocarditis in the other five. Clinical follow-up studies of the five patients apparently confirmed the morphological results, because in no case was there clinical deterioration, three patients in fact being in a fairly normal cardiac state at present. Using a morphological scoring system, the 19 patients with morphologically confirmed diagnosis of CCM were subdivided into two groupds, those with four points or less (group I, n equal to 9), and those with five pints or more (group II, n equal to 10). During a mean follow-up period of nearly 12 months the first group had a low mortality rate (n equal to 2), while the other had a high one (n equal to 6). The occurrence of signs of degeneration and mitochondrial alterations, in particular, was associated with a poor clinical prognosis. This differentiation into two groupds could not be achieved by clinical means alone. Type B3 Coxsackie virus was isolated from one biopsy, but no patient had significant serological evidence of virological infection.

Special investigations of COCM: endomyocardial biopsies (morphological analysis)

“…The number of 'other pathology' is small and myocarditis was found in only fourteen cases of a total number of 237 patients investigated. In a series of twenty-five patients suspected of suffering from congestive cardiomyopathy, five were shown to have myocarditis and another patient storage disease (Kuhn et al, 1975). In the series of MacKay, Littler and Sleight (1978) involving many cardiac conditions, an overall figure of 10% of unexpected pathology was found.…”

Nuclear Hypertrophy Reflects Increased Biosynthetic Activities in Myocytes of Human Hypertrophic Hearts

“…The nuclear change has been well characterized as "hypertrophied nucleus" by the morphological hallmarks of severe crenation of the nuclear membrane (bizarre shape) and widespread clumping of chromatin. [3][4][5] However, the significance of such dramatic alteration of the nuclear phenotype in hypertrophic hearts is largely unknown. We previously reported that hypertrophied nuclei in the myocytes of human hearts with dilated cardiomyopathy (DCM) were accompanied by increased activity of DNA repair/synthesis.…”

Zur Pathomorphologie chronischer alkohol-assoziierter Myokardver�nderungen

“…Aul3erdem wurden diese Befunde zum gr613ten Teil durch Endo-MyokardBiopsien yon Alkoholikern gesichert und durch die weitgehende Reversibilitgt nach Abstinenz belegt (Ferriere et al 1983;Kouvaras und Gokkinos 1986;Walsh und Vaak 1986). Aufgrund dieser Beobachtungen und der Ahnlichkeit mit den Befunden bestimmter F~ille der kongestiven Kardiomyopathie wurde vermutet, dab Alkohol eine der vielf~iltigen unklaren Ursachen der kongestiven Kardiomyopathie darstellt (Goodwin 1974;Ferrans et al 1965;Kuhn et al 1975;Davies 1984;Kouvaras et al 1986). Auch wenn in der vorliegenden Untersuchung keine Unterschiede zwischen den Alkoholikern und den als regelm~iBig beschriebenen Trinkern ersichtlich sind, hebt sich die Vergleichsgruppe yon den beiden Gruppen deutlich ab.…”