title: Endomyocardial biopsy foretells ventricular function recovery after coronary artery bypass grafting.
abstract: OBJECTIVE
  Patients with ischemic heart failure may benefit from coronary artery bypass grafting. The histopathological variables associated with improvement in ejection fraction 6 months after surgery were assessed.
  
  
  METHODS
  This study comprised 24 patients indicated for coronary artery bypass grafting, ejection fraction < 35%, functional class II-IV heart failure, and mean age 59 +/- 9 years. Endomyocardial biopsies were performed during and 6 months after surgery. Extension of the fibrosis, number of cells with myocytolysis, and hypertrophy of the muscle fiber were quantified by using a system of image analysis. Clinical and functional review was repeated within 6 months.
  
  
  RESULTS
  A significant improvement in heart failure functional class was observed in 16 patients after 6 months of follow-up (from NYHA functional class 2.8 +/- 0.7 to 1.7 +/- 0.6; P < 0.001), but the ejection fraction did not change (25 +/- 6 % vs. 26 +/- 10%). Hypertrophy of the muscle fiber was similar in the specimens biopsied in the pre- and postoperative periods (21 +/- 4 vs. 22 +/- 4 microm), but the extension of fibrosis (8 +/- 8 vs. 21 +/- 15% area) and the number of cells with myocytolysis (9 +/- 11 vs. 21 +/- 15% cell) significantly increased. However, the composition of a histological score combining those 3 variables indicated a greater increase in the ventricular function of those with a lower degree of preoperative histopathological alterations.
  
  
  CONCLUSIONS
  Patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting improved their ventricular function when the preoperative adverse histopathological alterations were of a lower degree.
authors.affiliation: Instituto de Cardiologia do RS, Fundação Universitária de Cardiologia, Fundação Federal de Ciências Médicas de Porto Alegre, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil. moreno.pesquisa@cardiologia.org.br
authors.forename: Paulo L
authors.initials: PL
authors.lastname: Moreno
authors.forename: Orlando B
authors.initials: OB
authors.lastname: Wender
authors.forename: Marinez
authors.initials: M
authors.lastname: Barra
authors.forename: Lucia C
authors.initials: LC
authors.lastname: Pellanda
authors.forename: Luiz E
authors.initials: LE
authors.lastname: Rohde
authors.forename: Nadine
authors.initials: N
authors.lastname: Clausell
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D002303:Cardiac Output, Low / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D001026:Coronary Artery Bypass; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D009206:Myocardium / Q000473:pathology*; D011184:Postoperative Period; D015635:Radionuclide Ventriculography; D013318:Stroke Volume; D016276:Ventricular Function