title: Ultrastructural morphometric findings of cardiomyocytes in patients with impaired ventricular function--a comparative clinicopathological study.
abstract: OBJECTIVE
  The present study aims to analyze the differences in ultrastructural changes between right ventricular myocardium in clinically determined grades of heart failure (HF) [New York Heart Association (NYHA) classes I-IV] and their value in the routine diagnostic setting.
  
  
  METHODS
  We investigated consecutive right ventricular endomyocardial biopsies of 12 patients presenting with HF (49±11.2years; male=10) by light microscopy and ultrastructural morphometric analysis. The patients were divided into four groups according to their NYHA classes (NYHA I: n=1, II: n=2, III: n=8, IV: n=1). We used a stereological point counting method on electron micrographs to determine the volume, surface, and numerical density of cardiomyocyte myofibrils; z-lines; mitochondria; and cristae as required. Further, secondary parameters were calculated.
  
  
  RESULTS
  Myofibrillar parameters increased between NYHA class I and II (P<.01), which matched with more pronounced cardiomyocyte hypertrophy on the light microscopic level. In NYHA classes III and IV, the myofibrillar parameters dropped, while parameters concerning the mitochondria and their cristae rose (P<.01). This resulted in an elevated mitochondria to myofibril ratio (P<.05) and correlated with histologically evident atrophic cardiomyocytes, perinuclear loss of myofibrils and dot-like perinuclear staining positive on peroxide acid shift.
  
  
  CONCLUSIONS
  In this present study, right ventricular myocardial ultrastructure differed between patients diagnosed with HF of different degrees in distinct subcellular changes. These findings suggest that ultrastructural analysis, while correlated with histopathological features, adds to the diagnosis in the routine diagnostic setting, specifically in lower NYHA grades, in which only minor changes are observed histologically.
authors.affiliation: Cardiac Pathology Unit, Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany. Electronic address: wassilew@dhzb.de.
authors.forename: Katharina
authors.initials: K
authors.lastname: Wassilew
authors.affiliation: Institute of Anatomy, Medical University Leipzig, Leipzig, Germany.
authors.forename: Denis
authors.initials: D
authors.lastname: Terziev
authors.affiliation: Private Histopathology Laboratory, Berlin, Germany.
authors.forename: Georgi
authors.initials: G
authors.lastname: Wassilew
authors.affiliation: Institute of Anatomy, Medical University Leipzig, Leipzig, Germany.
authors.forename: Günther
authors.initials: G
authors.lastname: Fitzl
authors.affiliation: FNS Personal und Informationssysteme GmbH, Berlin, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Frölich
authors.affiliation: Department of Molecular Pathology, Institute of Pathology and Neuropathology, Tübingen, Germany.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kandolf
authors.affiliation: Department of Cardiology, Hospital Havelhoehe, Berlin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Fried
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D006333:Heart Failure / Q000473:pathology* / Q000503:physiopathology / Q000821:virology; D006801:Humans; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D008929:Mitochondria, Heart / Q000648:ultrastructure; D032383:Myocytes, Cardiac / Q000648:ultrastructure* / Q000821:virology; D009210:Myofibrils / Q000648:ultrastructure; D018497:Ventricular Dysfunction, Right / Q000473:pathology* / Q000503:physiopathology / Q000821:virology; D016278:Ventricular Function, Right
chemical_list: D004279:DNA, Viral
keywords: Electron microscopy; Heart failure; Stereology