Coronary atherosclerosis in end-stage idiopathic dilated cardiomyopathy: an innocent bystander?
OBJECTIVE
Coronary atherosclerosis is occasionally found in the hearts of patients diagnosed with idiopathic dilated cardiomyopathy (IDCM), who have undergone heart transplantation (HTx). This study investigates the pathology of coronary trees in IDCM patients and correlates the findings with risk factors for atherosclerosis.


RESULTS
The coronary trees of hearts excised at transplantation from 55 IDCM patients [43 males, mean (+/-SD) age at diagnosis and HTx: 37.4+/-13.4 and 42.1+/-14.6 years, respectively] underwent systematic pathological investigation. The inclusion criteria were: interval between the last pre-HTx angiography and the HTx of <10 years and the absence of ischaemic events in between; the absence of ventricular scars at pathological study; optimal pre-HTx medical treatment, and no ventricular assist devices. The median time between the pre-HTx angiography and the HTx was 13 months (range: 1-93). Fifteen of the 55 patients (27%) had critical plaques in at least one of the 70 segments of the epicardial coronary tree. A multivariate statistical analysis showed that male sex, age, and dyslipidaemia were independent predictors of critical atherosclerosis.


CONCLUSIONS
One-fourth of the patients with end-stage IDCM hearts excised at HTx (all with angiographically normal coronary arteries at first diagnosis) have bystander critical coronary atherosclerosis whose functional role (if any) deserves investigation.
Repetto
Alessandra
A
Department of Cardiology, IRCCS Policlinico San Matteo, Piazzale Golgi 2, 27100 Pavia, Italy.
Dal Bello
Barbara
B
Pasotti
Michele
M
Agozzino
Manuela
M
Viganò
Mario
M
Klersy
Catherine
C
Tavazzi
Luigi
L
Arbustini
Eloisa
E
D000328:Adult; D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D003324:Coronary Artery Disease / Q000150:complications* / Q000473:pathology / Q000601:surgery; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors