Makarov Igor, Voronkina Daria, Gurshchenkov Alexander, Ryzhkov Anton, Starshinova Anna, Kudlay Dmitry, Mitrofanova Lubov
Almazov National Medical Research Centre, St. Petersburg 197341, Russia.
Department of Pharmacognosy and Industrial Pharmacy, Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow 119991, Russia.
J Clin Med. 2024 May 31;13(11):3275. doi: 10.3390/jcm13113275.
Myocardial fibrosis is an important factor in the progression of cardiovascular diseases. However, there is still no universal lifetime method of myocardial fibrosis assessment that has a high prognostic significance. The aim of the study was to determine the significance of ventricular endomyocardial biopsies for the assessment of myocardial fibrosis and to identify the severity of myocardial fibrosis in different cardiovascular diseases. Endomyocardial biopsies (EMBs) of 20 patients with chronic lymphocytic myocarditis (CM), endomyocardial fragments obtained during septal reduction of 21 patients with hypertrophic cardiomyopathy (HCM), and 36 patients with a long history of hypertensive and ischemic heart disease (HHD + IHD) were included in the study. The control group was formed from EMBs taken on 12-14 days after heart transplantation (n = 28). Also, for one patient without clinical and morphological data for cardiovascular pathology, postmortem myocardial fragments were taken from typical EMB and septal reduction sites. The relative area of fibrosis was calculated as the ratio of the total area of collagen fibers to the area of the whole biopsy. Endocardium and subendocardial fibrosis were not included in the total biopsy area. The relative fibrosis area in the EMBs in the CM patient group was 5.6 [3.3; 12.6]%, 11.1 [6.6; 15.9]% in the HHD + IHD patient group, 13.4 [8.8; 16.7]% in the HCM patient group, and 2.7 [1.5; 4.6]% in the control group. When comparing the fibrosis area of the CM patients in repeat EMBs, it was found that the fibrosis area in the first EMBs was 7.6 [4.8; 12.0]%, and in repeat EMBs, it was 5.3 [3.2; 7.6]%. No statistically significant differences were found between the primary and repeat EMBs ( = 0.15). In ROC analysis, the area of fibrosis in the myocardium of 1.1% (or lower than one) was found to be highly specific for the control group of patients compared to the study patients. EMB in the assessment of myocardial fibrosis has a questionable role because of the heterogeneity of fibrotic changes in the myocardium.
心肌纤维化是心血管疾病进展的一个重要因素。然而，目前仍没有一种具有高预后意义的通用的终生心肌纤维化评估方法。本研究的目的是确定心室心内膜活检对于评估心肌纤维化的意义，并确定不同心血管疾病中心肌纤维化的严重程度。本研究纳入了20例慢性淋巴细胞性心肌炎（CM）患者的心内膜活检、21例肥厚型心肌病（HCM）患者在室间隔减容术中获取的心肌碎片以及36例有高血压和缺血性心脏病（HHD + IHD）病史的患者。对照组由心脏移植术后12 - 14天获取的心内膜活检组织组成（n = 28）。此外，对于1例无心血管病理临床和形态学数据的患者，从典型的心内膜活检和室间隔减容部位获取了尸检心肌碎片。纤维化相对面积计算为胶原纤维总面积与整个活检面积的比值。心内膜和心内膜下纤维化不包括在总活检面积内。CM患者组心内膜活检中的相对纤维化面积为5.6 [3.3; 12.6]%，HHD + IHD患者组为11.1 [6.6; 15.9]%，HCM患者组为13.4 [8.8; 16.7]%，对照组为2.7 [1.5; 4.6]%。在比较CM患者重复心内膜活检的纤维化面积时，发现首次心内膜活检中的纤维化面积为7.6 [4.8; 12.0]%，重复心内膜活检中的纤维化面积为5.3 [3.2; 7.6]%。首次和重复心内膜活检之间未发现统计学显著差异（P = 0.15）。在ROC分析中，发现心肌纤维化面积为1.1%（或低于1%）对对照组患者与研究患者相比具有高度特异性。由于心肌纤维化变化的异质性，心内膜活检在评估心肌纤维化方面的作用存在疑问。
