title: Allograft pathology in patients transplanted for idiopathic dilated cardiomyopathy.
abstract: There are few morphologic studies on idiopathic dilated cardiomyopathy (CM) treated with transplant. We prospectively correlated gross, histologic, and clinical findings pertaining to hearts explanted in a 5-year period from patients with a clinical diagnosis of nonischemic CM and also correlated left ventricular diameter with preoperative echocardiographic reports. Of 64 patients with a clinical diagnosis of dilated cardiomyopathy (DC), 42 were men (age, 51 ± 13 y) and 22 were women (age, 42 ± 18 y). The pathologic diagnosis was idiopathic (dilated) cardiomyopathy (DC) in 55 patients (86%) and features of specific CM in 9 patients (14%). Specific diagnoses were fibrofatty change consistent with arrhythmogenic right ventricular cardiomyopathy (n=6), amyloidosis (n=2), and sarcoidosis (n=1), none of which were suspected clinically. The 55 hearts with idiopathic DC had a mean heart weight of 508 (range, 220 to 980) g. Pathologic subsets of the DC group included 4 hearts without enlargement, cavity dilatation, or significant histologic findings (minimal DC); 3 hearts with histologic evidence of healed myocarditis; and 5 hearts with mildly noncompacted left ventricle with hypertrabeculation. Five patients had prior mitral or tricuspid valve replacement/repairs to manage heart failure. There were 7 postpartum DC cases, 1 with a histologic pattern of healed myocarditis and 1 alcoholism-associated DC. Familial DC comprised 16% (9 of 55) of patients. In patients without prior assist device placement, pathologic left ventricular cavity diameter correlated with echocardiographic end-diastolic volume (r , 0.8, P<0.0001). Morphologically, DC is a heterogeneous group. Areas of fibrofatty change and features of noncompaction are not uncommon. Left ventricular measurement at explant correlates well with echocardiographic findings, with a relatively consistent underestimation of the diameter.
authors.affiliation: University of Maryland, School of Medicine, Baltimore, MD 21201, USA.
authors.forename: Mingchang
authors.initials: M
authors.lastname: Zhang
authors.forename: Fabio
authors.initials: F
authors.lastname: Tavora
authors.forename: Thomas
authors.initials: T
authors.lastname: Huebner
authors.forename: Jonathan
authors.initials: J
authors.lastname: Heath
authors.forename: Allen
authors.initials: A
authors.lastname: Burke
mesh_terms: D000328:Adult; D000368:Aged; D000686:Amyloidosis / Q000473:pathology / Q000601:surgery; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000473:pathology / Q000601:surgery; D001706:Biopsy; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005355:Fibrosis; D016027:Heart Transplantation; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012507:Sarcoidosis / Q000473:pathology / Q000601:surgery; D014184:Transplantation, Homologous; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000473:pathology / Q000601:surgery