Is Immunohistochemistry a Useful Tool in the Postmortem Recognition of Myocardial Hypoxia in Human Tissue with No Morphological Evidence of Necrosis?

Myocytes in the border zone of myocardial infarction are under severe hypoxia without characteristic morphology of necrosis, and show ultrastructural features similar to those seen within the first hours after coronary occlusion. This study was carried out to evaluate the possibility that immunohistochemical methods could be used for the early diagnosis of myocardial infarction by detecting areas of hypoxia. Nineteen human sections of formalin-fixed paraffin-embedded myocardial samples showing a necrotic area and its border were submitted to immunohistochemical staining with the markers antimuscle actin, antimyoglobin, antitroponin T, antifibronectin, and anticomplement component C9. Sections were also subjected to azan trichrome and hematoxylin-basic fuchsin-picric (HBFP) staining techniques. Immunohistochemistry and azan trichrome showed that in the border zone there was a pattern of reaction intermediate between the infarcted area and the normal myocardium. The HBFP failed to distinguish these two areas. In conclusion, immunohistochemistry and azan trichrome can recognize myocardial hypoxia. Because hypoxia is an invariable condition in infarction, these techniques can be used to confirm suspected cases of myocardial infarction in which necrosis is not yet evident. However, considering that agonal states may be associated with generalized hypoxia, further studies are needed to confirm the reliability of this procedure in the earlier phases of myocardial infarction.