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European Heart Journal Advance Access originally published online on May 25, 2005
European Heart Journal 2005 26(15):1519-1527; doi:10.1093/eurheartj/ehi342
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

Coronary atherosclerosis in end-stage idiopathic dilated cardiomyopathy: an innocent bystander?

Alessandra Repetto1, Barbara Dal Bello2, Michele Pasotti1, Manuela Agozzino2, Mario Viganò3, Catherine Klersy4, Luigi Tavazzi1 and Eloisa Arbustini2,*

1Department of Cardiology, IRCCS Policlinico San Matteo, Piazzale Golgi 2, 27100 Pavia, Italy
2Molecular Diagnostics, Cardiovascular and Transplant Pathology Laboratory, Transplant Research Area, IRCCS Policlinico San Matteo, Via Forlanini 16, 27100 Pavia, Italy
3Dubost Transplant Centre, University of Pavia, IRCCS Policlinico San Matteo, Piazzale Golgi 2, 27100 Pavia, Italy
4Clinical Epidemiology and Biometry Service, IRCCS Policlinico San Matteo, Piazzale Golgi 2, 27100 Pavia, Italy

Received 8 December 2004; revised 23 April 2005; accepted 28 April 2005; online publish-ahead-of-print 25 May 2005.

* Corresponding author. Tel: +39 0382 501206; fax: +39 0382 525866. E-mail address: e.arbustini{at}smatteo.pv.it

Aims Coronary atherosclerosis is occasionally found in the hearts of patients diagnosed with idiopathic dilated cardiomyopathy (IDCM), who have undergone heart transplantation (HTx). This study investigates the pathology of coronary trees in IDCM patients and correlates the findings with risk factors for atherosclerosis.

Methods and results The coronary trees of hearts excised at transplantation from 55 IDCM patients [43 males, mean (±SD) age at diagnosis and HTx: 37.4±13.4 and 42.1±14.6 years, respectively] underwent systematic pathological investigation. The inclusion criteria were: interval between the last pre-HTx angiography and the HTx of <10 years and the absence of ischaemic events in between; the absence of ventricular scars at pathological study; optimal pre-HTx medical treatment, and no ventricular assist devices. The median time between the pre-HTx angiography and the HTx was 13 months (range: 1–93). Fifteen of the 55 patients (27%) had critical plaques in at least one of the 70 segments of the epicardial coronary tree. A multivariate statistical analysis showed that male sex, age, and dyslipidaemia were independent predictors of critical atherosclerosis.

Conclusion One-fourth of the patients with end-stage IDCM hearts excised at HTx (all with angiographically normal coronary arteries at first diagnosis) have bystander critical coronary atherosclerosis whose functional role (if any) deserves investigation.

Key Words: Idiopathic dilated cardiomyopathy (IDCM) • Heart transplantation (HTx) • Atherosclerosis • Risk factors


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