title: Nonpredictive value of fibrosis in dilated cardiomyopathy treated with metoprolol.
abstract: Therapy with β-adrenergic blocking agents has been advocated as a potential useful approach in heart failure. Recent studies suggest that histologic parameters may be helpful in assessing the effectiveness of β-blocker treatment in dilated cardiomyopathy (DCM). In order to predict the response to β-blockers in DCM, fibrous tissue was evaluated at endomyocardial biopsy (EMB) in 45 patients (pts) with a mean left ventricular ejection fraction of 0.28 ± 0.07, who were successively long-term treated with metoprolol (M) (mean dosage 138 ±26 mg/die). EMB was performed from left (n = 32) or right (n = 13) ventricle by means of a King's bioptome or the Cordis adaptation of this instrument. Quantification of fibrous tissue was performed at 9 × magnification and with a computerized morphometric system. Qualitative evaluation at light microscopy distinguished four types of fibrosis: pericellular, perivascular, focal, and endocardial. Volume fraction of fibrous tissue ranged from 1.3 to 35.5% (mean 12.1 ± 9.3%) and was not significantly correlated with any clinical variable considered. After 24 ± 12 months of treatment, 25 pts were considered improved (group A), whereas the remaining 20 pts were considered not improved (group B), according to criteria based on ejection fraction, left ventricular end-diastolic diameter, filling pattern at Doppler-Echocardiography, cardiothoracic ratio, NYHA functional class, and exercise duration at ergometric test. Volume fraction of fibrous tissue did not differ significantly between the two groups (group A = 12.1 ± 9.1%; group B = 11.3 ± 9.6%;p = NS). Dominant pericellular type of fibrosis was equally distributed between the two groups (group A = 9 25 pts, 36%; group B = 10 20 pts, 50%), whereas a perivascular and/or focal replacement fibrosis was more frequent in group A (group A = 10 20 pts, 50%; group B = 2 20 pts, 10%; p = .05, OR 5.55 at univariate analysis). At multivariate analysis mean aortic blood pressure was the only variable discriminating the two groups; the type of fibrosis, although not statistically significant, maintained a high value of odds-ratio (5.23). In conclusion, extent of total fibrosis assessed by EMB may range widely in patients with DCM, is not correlated with the most important clinical variables, and is not predictive of long-term response to β-blocker treatment. Otherwise, prevalent perivascular and/or focal replacement fibrosis could be associated with a higher probability of improvement after long-term β-blocker treatment.
authors: Cardiology Department, Ospedale Maggiore and University, Trieste, Italy.
authors: G
authors: G
authors: Sinagra
authors: Cardiology Department, Ospedale Maggiore and University, Trieste, Italy.
authors: S
authors: S
authors: Rakar
authors: Cardiology Department, Ospedale Maggiore and University, Trieste, Italy.
authors: M
authors: M
authors: Zecchin
authors: Cardiology Department, Ospedale Maggiore and University, Trieste, Italy; Morbid Anatomy Department, Ospedale Maggiore and University, Trieste, Italy.
authors: R
authors: R
authors: Bussani
authors: Cardiology Department, Ospedale Maggiore and University, Trieste, Italy; Morbid Anatomy Department, Ospedale Maggiore and University, Trieste, Italy.
authors: F
authors: F
authors: Silvestri
authors: Cardiology Department, Ospedale Maggiore and University, Trieste, Italy; Morbid Anatomy Department, Ospedale Maggiore and University, Trieste, Italy.
authors: F
authors: F
authors: Bassan
authors: Cardiology Department, Ospedale Maggiore and University, Trieste, Italy; Department of Statistics, Pennsylvania State University, State College, Pennsylvania, USA.
authors: D
authors: D
authors: Gregori
authors: Cardiology Department, Ospedale Maggiore and University, Trieste, Italy.
authors: A
authors: A
authors: Perkan
authors: Cardiology Department, Ospedale Maggiore and University, Trieste, Italy.
authors: A
authors: A
authors: Di Lenarda
authors: Cardiology Department, Ospedale Maggiore and University, Trieste, Italy.
authors: G
authors: G
authors: Secoli
authors: Cardiology Department, Ospedale Maggiore and University, Trieste, Italy.
authors: G
authors: G
authors: Lardieri
authors: Cardiology Department, Ospedale Maggiore and University, Trieste, Italy.
authors: F
authors: F
authors: Camerini