title: Clinical variables associated with the presence of inflammatory infiltrates in patients with dilated cardiomyopathy undergoing heart transplantation.
abstract: BACKGROUND
  Idiopathic dilated cardiomyopathy (DCM) is, together with ischemic heart disease, the major cause of end-stage heart failure leading to heart transplantation. However, an unknown percentage of patients with this diagnosis has inflammatory foci found in the histopathological study of the explanted heart. This fact suggests an undetected process of acute myocarditis as the cause of cardiac dysfunction.
  
  
  OBJECTIVE
  The objective of this study was to identify clinical and echocardiographic variables related to the presence of myocardial infiltrates, as a potential guide to determine which patients should undergo endomyocardial biopsy in DCM.
  
  
  METHODS
  We retrospectively analyzed 161 patients who underwent heart transplantation with a diagnosis of DCM between 1987 and 2007. The presence of inflammatory infiltrates was considered significant when the histopathological study of tissue blocks from the left ventricle showed 1 or more foci per cm(2) of perivascular or interstitial mononuclear or polymorphonuclear cells, whether or not in the presence of cytolysis.
  
  
  RESULTS
  Seventeen patients (11%) had these inflammatory histological findings; of them, 6 (35%) showed preponderance of eosinophils and 7 (41%) showed areas of cytolysis. The DCM group with inflammatory infiltrates showed significant differences in terms of younger age (45 +/- 15 vs 50 +/- 11 years; P < .01) and smaller ventricular diameters (P < .05). Male gender was more frequent in this group, and the patients had a poorer clinical status and greater dependence on inotropic drugs.
  
  
  CONCLUSIONS
  Inflammatory infiltrates are frequently present in DCM explanted hearts. Although there are no relevant clinical variables to identify subclinical myocarditis, these patients are younger and have smaller ventricular diameters and poorer functional status at the time of transplantation.
authors.affiliation: Heart Failure and Transplant Unit, Department of Cardiology, La Fe University Hospital, Valencia, Spain. jaimeaguero30@hotmail.com
authors.forename: J
authors.initials: J
authors.lastname: Agüero
authors.forename: J
authors.initials: J
authors.lastname: Navarro
authors.forename: M C
authors.initials: MC
authors.lastname: Medina
authors.forename: L
authors.initials: L
authors.lastname: Almenar
authors.forename: M
authors.initials: M
authors.lastname: Chirivella
authors.forename: L
authors.initials: L
authors.lastname: Martínez-Dolz
authors.forename: J A
authors.initials: JA
authors.lastname: Moro
authors.forename: I
authors.initials: I
authors.lastname: Sánchez-Lazaro
authors.forename: V
authors.initials: V
authors.lastname: Ortiz
authors.forename: R
authors.initials: R
authors.lastname: Raso
authors.forename: A
authors.initials: A
authors.lastname: Salvador
mesh_terms: D000328:Adult; D001706:Biopsy; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004280:Dobutamine / Q000627:therapeutic use; D004452:Echocardiography; D004804:Eosinophils / Q000473:pathology; D005260:Female; D016027:Heart Transplantation / Q000502:physiology*; D006352:Heart Ventricles / Q000033:anatomy & histology / Q000473:pathology; D006801:Humans; D007249:Inflammation / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D012189:Retrospective Studies; D012727:Sex Characteristics
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine