Key result
End-stage dilated cardiomyopathy is linked to marked LV glycogen accumulation and reduced capillary density.
Observational (n=31)
Single-blind
Morphological and molecular features of myocardial hibernation are present in end-stage idiopathic dilated cardiomyopathy despite the absence of epicardial coronary stenosis, suggesting shared pathophysiological mechanisms with ischaemic cardiomyopathy.
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These features should not alter management in non-ischemic DCM; leaves open shared mechanisms with ischemic cardiomyopathy.
Myocardial hibernation (MH) is a well-known feature of human ischaemic cardiomyopathy (ICM), whereas its presence in human idiopathic dilated cardiomyopathy (DCM) is still controversial. We investigated the histological and molecular features of MH in left ventricle (LV) regions of failing DCM or ICM hearts. We examined failing hearts from DCM (n = 11; 41.9 ± 5.45 years; left ventricle-ejection fraction (LV-EF), 18 ± 3.16%) and ICM patients (n = 12; 58.08 ± 1.7 years; LVEF, 21.5 ± 6.08%) undergoing cardiac transplantation, and normal donor hearts (N, n = 8). LV inter-ventricular septum (IVS) and antero-lateral free wall (FW) were transmurally (i.e. sub-epicardial, mesocardial and sub-endocardial layers) analysed. LV glycogen content was shown to be increased in both DCM and ICM as compared with N hearts (P < 0.001), with a U-shaped transmural distribution (lower values in mesocardium). Capillary density was homogenously reduced in both DCM and ICM as compared with N (P < 0.05 versus N), with a lower decrease independent of the extent of fibrosis in sub-endocardial and sub-epicardial layers of DCM as compared with ICM. HIF1-α and nestin, recognized ischaemic molecular hallmarks, were similarly expressed in DCM-LV and ICM-LV myocardium. The proteomic profile was overlapping by ~50% in DCM and ICM groups. Morphological and molecular features of MH were detected in end-stage ICM as well as in end-stage DCM LV, despite epicardial coronary artery patency and lower fibrosis in DCM hearts. Unravelling the presence of MH in the absence of coronary stenosis may be helpful to design a novel approach in the clinical management of DCM.
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Lionetti et al. (2014) conducted an observational in Idiopathic end-stage dilated cardiomyopathy and ischaemic cardiomyopathy (n=31). Idiopathic end-stage dilated cardiomyopathy (DCM) vs. Ischaemic cardiomyopathy (ICM) and normal donor hearts was evaluated on Left ventricular histological and molecular hallmarks of myocardial hibernation (glycogen content, capillary density, HIF-1alpha and nestin expression) (p=<0.001). End-stage dilated cardiomyopathy hearts exhibited significant left ventricular glycogen accumulation and reduced capillary density compared to normal donor hearts.
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