title: Ultrastructural features of cardiomyocytes in dilated cardiomyopathy with initially decompensated heart failure as a predictor of prognosis.
abstract: OBJECTIVE
  The aim of the present study was to clarify the significance of myocardial ultrastructural changes in patients with dilated cardiomyopathy (DCM).
  
  
  RESULTS
  Endomyocardial biopsy of the left ventricle was performed in 250 consecutive DCM patients (54.9 ± 13.9 years, 79% men), presenting initially as decompensated heart failure (HF). Myofilament changes of cardiomyocytes were evaluated by electron microscopy and compared with clinical and morphometric data. Mortality and HF recurrence were evaluated during the follow-up period. During the follow-up period (4.9 ± 3.9 years), 24 patients (10%) died and 67 (27%) were readmitted because of HF recurrence, including those who had died because of HF. Myofilament changes, classified as either focal derangement of myofilaments (sarcomere damage) or diffuse myofilament lysis (disappearance of most sarcomeres in cardiomyocytes), were identified in 164 patients (66%). Multivariate analysis identified a family history of DCM [hazard ratio (HR) 4.763; 95% confidence interval (CI) 1.012-12.518], atrial fibrillation (HR 6.132; 95% CI 2.188-17.180), haemoglobin level (HR 0.685; 95% CI 0.528-0.889), and diffuse myofilament lysis (HR 4.048; 95% CI 1.427-11.481) as independent predictors of mortality. A family history of DCM (HR 2.268; 95% CI 1.276-4.030), haemoglobin level (HR 0.876; 95% CI 0.785-0.979), focal derangement of myofilaments (HR 7.431; 95% CI 2.916-18.934), and diffuse myofilament lysis (HR 6.480; 95% CI 2.403-17.473) were predictors of readmission due to HF recurrence.
  
  
  CONCLUSIONS
  In DCM patients with first-decompensated HF, myofilament changes are strongly associated with mortality and HF recurrence.
authors.affiliation: Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan tnsaitonms@gmail.com.
authors.forename: Tsunenori
authors.initials: T
authors.lastname: Saito
authors.affiliation: Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
authors.forename: Kuniya
authors.initials: K
authors.lastname: Asai
authors.affiliation: Central Electron Microscopic Institute, Nippon Medical School, Tokyo, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Sato
authors.affiliation: Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Takano
authors.affiliation: Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Mizuno
authors.affiliation: Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Shimizu
mesh_terms: D008841:Actin Cytoskeleton / Q000648:ultrastructure; D002311:Cardiomyopathy, Dilated / Q000401:mortality / Q000473:pathology*; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000473:pathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D032383:Myocytes, Cardiac / Q000648:ultrastructure*; D011379:Prognosis; D011446:Prospective Studies
keywords: Dilated cardiomyopathy; Electron microscopy; Endomyocardial biopsy; Heart failure; Myofilament changes