Hypertrophic cardiomyopathy: the interrelation of disarray, fibrosis, and small vessel disease.
OBJECTIVE
To make a quantitative assessment of the relation between disarray, fibrosis, and small vessel disease in hypertrophic cardiomyopathy.


METHODS
Detailed macroscopic and histological examination at 19 segments of the left and right ventricle and the left atrial free wall.


METHODS
72 patients with hypertrophic cardiomyopathy who had suffered sudden death or progression to end stage cardiac failure (resulting in death or heart transplantation).


METHODS
The presence of scarring, atrial dilatation, and a mitral valve impact lesion were noted, and heart weight, wall thickness, per cent disarray, per cent fibrosis, and per cent small vessel disease quantitated for each heart.


RESULTS
Within an individual heart the magnitude of hypertrophy correlated with the severity of fibrosis (p = 0.006) and disarray (p = 0.0002). Overall, however, total heart weight related weakly but significantly to fibrosis (r = 0.4, p = 0.0001) and small vessel disease (r = 0.3, p = 0.03), but not to disarray. Disarray was greater in hearts with mild left ventricular hypertrophy (maximum wall thickness < 20 mm) and preserved systolic function (60.9 (26)% v 43 (20.4)% respectively, p = 0.02) and hearts without a mitral valve impact lesion (26.3% v 18.9%, p = 0.04), but was uninfluenced by sex. Fibrosis was influenced by sex (7% in male patients and 4% in female, p = 0.04), but not by the presence of an impact lesion. No relation was found between disarray, fibrosis, and small vessel disease.


CONCLUSIONS
Myocyte disarray is probably a direct response to functional or structural abnormalities of the mutated sarcomeric protein, while fibrosis and small vessel disease are secondary phenomena unrelated to disarray, but modified by factors such as left ventricular mass, sex, and perhaps local autocrine factors.
Varnava
A M
AM
Department of Cardiovascular Pathology, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK. avarnava@sghms.ac.uk
Elliott
P M
PM
Sharma
S
S
McKenna
W J
WJ
Davies
M J
MJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002312:Cardiomyopathy, Hypertrophic / Q000473:pathology*; D002648:Child; D003327:Coronary Disease / Q000473:pathology*; D004108:Dilatation, Pathologic; D005260:Female; D005355:Fibrosis; D006325:Heart Atria / Q000473:pathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology; D009206:Myocardium / Q000473:pathology; D009929:Organ Size