title: Increased myocardial apoptosis in patients with unfavorable left ventricular remodeling and early symptomatic post-infarction heart failure.
abstract: OBJECTIVE
  The purpose of this study was to evaluate a potential correlation between apoptotic rate (AR), post-infarction left ventricular (LV) remodeling, and clinical characteristics in subjects who died late (>or=10 days) after an acute myocardial infarction (AMI) with evidence of persistent occlusion of the infarct-related artery at autopsy.
  
  
  BACKGROUND
  Apoptosis contributes to myocardiocyte loss in cardiac disease and may have a pathophysiologic role in post-infarction LV remodeling.
  
  
  METHODS
  The AR was calculated at the site of infarction and in remote unaffected LV regions, using co-localization of in situ end labeling for deoxyribonucleic acid fragmentation and immunohistochemistry for caspase-3, in 14 subjects who died within two months after AMI. Correlation between AR and clinical characteristics such as age, site of AMI, transmural extension, multivessel coronary disease, and signs and/or symptoms of heart failure (HF), at the time of initial hospitalization for AMI or subsequently before death, was assessed using non-parametric statistical tests. Parameters of LV remodeling including diameters, free wall thickness, diameter-to-wall-thickness ratio, and mass were measured at gross examination at autopsy. Values are expressed as median (interquartile range).
  
  
  RESULTS
  Among clinical variables, early symptomatic post-infarction HF (9 cases, 64%) was associated with nearly fourfold increased AR at the site of infarction (26.2% [24.5% to 28.8%] vs. 6.4% [1.9% to 13.3%], p = 0.001). Moreover, AR both at the site of infarction and in unaffected regions was significantly correlated with parameters of progressive LV remodeling (p < 0.05).
  
  
  CONCLUSIONS
  Our data show that in patients dying >or=10 days after AMI, myocardial apoptosis is strongly associated with and may be a major determinant of unfavorable LV remodeling and early symptomatic post-infarction HF.
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. abbatea@yahoo.com
authors.forename: Antonio
authors.initials: A
authors.lastname: Abbate
authors.forename: Giuseppe G L
authors.initials: GG
authors.lastname: Biondi-Zoccai
authors.forename: Rossana
authors.initials: R
authors.lastname: Bussani
authors.forename: Aldo
authors.initials: A
authors.lastname: Dobrina
authors.forename: Debora
authors.initials: D
authors.lastname: Camilot
authors.forename: Florinda
authors.initials: F
authors.lastname: Feroce
authors.forename: Raffaele
authors.initials: R
authors.lastname: Rossiello
authors.forename: Feliciano
authors.initials: F
authors.lastname: Baldi
authors.forename: Furio
authors.initials: F
authors.lastname: Silvestri
authors.forename: Luigi M
authors.initials: LM
authors.lastname: Biasucci
authors.forename: Alfonso
authors.initials: A
authors.lastname: Baldi
mesh_terms: D000368:Aged; D017209:Apoptosis / Q000502:physiology*; D001344:Autopsy; D046508:Culture Techniques; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D020287:In Situ Nick-End Labeling; D016015:Logistic Models; D008297:Male; D032342:Muscle Cells / Q000473:pathology; D009203:Myocardial Infarction / Q000401:mortality* / Q000473:pathology*; D011336:Probability; D012307:Risk Factors; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D013997:Time Factors; D020257:Ventricular Remodeling / Q000502:physiology*