Campbell Duncan J, Francis Victoria C M, Young Gregory R, Woodford Noel W F
St. Vincent's Institute of Medical Research Fitzroy Victoria Australia.
University of Melbourne Parkville Victoria Australia.
J Am Heart Assoc. 2025 Apr 15;14(8):e039624. doi: 10.1161/JAHA.124.039624. Epub 2025 Apr 7.
This cohort study aimed to evaluate the potential myocardial arrhythmic substrate in people with coronary artery disease who died from sudden arrhythmic death (SAD) without acute coronary thrombosis or myocardial infarction.
We performed histological analysis of the left ventricular free wall obtained at autopsy from decedents with ≥1 coronary artery and ≥75% area stenosis who died suddenly from either noncardiac causes (25 men, 23 women) or SAD (25 men, 25 women), matched for age and sex. Decedents with acute coronary thrombosis, myocardial infarction, or other myocardial abnormality were excluded. Decedents with either noncardiac death or SAD had similar height, weight, and heart weight. Decedents with SAD had higher cumulative area stenosis of coronary arteries (mean, 162% versus 134%; mean difference, 29% [95% CI, 1%-56%], =0.042) and a higher proportion of decedents with SAD had diabetes (mean, 10% versus 0%; mean difference, 10% [95% CI, 2%-18%], =0.025) and chronic, nonocclusive, organized coronary artery thrombus (mean, 16% versus 0%; mean difference, 16% [95% CI, 6%-26%], =0.0040). Moreover, decedents with SAD had lower cardiomyocyte width (mean, 18.6 μm versus 19.6 μm; mean difference, 1.0 μm [95% CI, 0.2-1.8], =0.014) and higher capillary length density (mean, 3618 mm/mm versus 3164 mm/mm; mean difference, 453 mm/mm [95% CI, 210-697], =0.0003) than decedents with noncardiac death.
SAD in people with coronary artery disease without acute coronary thrombosis or myocardial infarction was associated with greater coronary artery plaque burden and cardiomyocyte atrophy that may have contributed to myocardial substrate for arrhythmia.
这项队列研究旨在评估在无急性冠状动脉血栓形成或心肌梗死的情况下死于心律失常性猝死（SAD）的冠心病患者潜在的心肌心律失常基质。
我们对年龄和性别匹配的死者尸检时获取的左心室游离壁进行了组织学分析，这些死者有≥1条冠状动脉且冠状动脉狭窄面积≥75%，他们死于非心脏原因（25名男性，23名女性）或SAD（25名男性，25名女性）。排除有急性冠状动脉血栓形成、心肌梗死或其他心肌异常的死者。死于非心脏原因或SAD的死者身高、体重和心脏重量相似。SAD死者的冠状动脉累积狭窄面积更高（平均值分别为162%和134%；平均差值为29%[95%CI，1%-56%]，P = 0.042），且SAD死者中患糖尿病的比例更高（平均值分别为10%和0%；平均差值为10%[95%CI，2%-18%]，P = 0.025）以及慢性、非闭塞性、机化性冠状动脉血栓形成的比例更高（平均值分别为16%和0%；平均差值为16%[95%CI，6%-26%]，P = 0.0040）。此外，与死于非心脏原因的死者相比，SAD死者的心肌细胞宽度更低（平均值分别为18.6μm和19.6μm；平均差值为1.0μm[95%CI，0.2 - 1.8]，P = 0.014），毛细血管长度密度更高（平均值分别为3618mm/mm和3164mm/mm；平均差值为453mm/mm[95%CI，210 - 697]，P = 0.0003）。
在无急性冠状动脉血栓形成或心肌梗死的冠心病患者中，SAD与更大的冠状动脉斑块负荷和心肌细胞萎缩相关，这可能促成了心律失常的心肌基质。
