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European Heart Journal 2000 21(4):296-305; doi:10.1053/euhj.1999.1744
Copyright © 2000 by the European Society of Cardiology.
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Increased digitalis-like immunoreactive substances in patients with hypertrophic cardiomyopathy

T Hayashia,f1, Y Ijirib, H Tokoa, H Shimomuraa, M Okabea, F Terasakia, Y Kitauraa and K Kawamuraa

a The Third Division, Department of Medicine, Osaka Medical College, Takatsuki, Osaka, Japan
b Department of Pharmacy, Osaka Medical College Hospital, Takatsuki, Osaka, Japan

revised April 6, 1999; accepted June 1, 1999

Abstract

Aims Although increased digitalis-like immunoreactive substances have been found in cases of hypertension and heart failure, no information is available about digitalis-like immunoreactive substances in patients with hypertrophic cardiomyopathy. We investigated digitalis-like immunoreactive substances in the plasma and biopsied specimens of patients with hypertrophic cardiomyopathy.

Methods and Results In 40 patients with hypertrophic cardiomyopathy (27 with the non-obstructive type and 13 with the obstructive type), the plasma concentration of digitalis-like immunoreactive substances was studied by fluorescence polarization immunoassay. Right ventricular endomyocardial biopsy specimens were analysed immunohistochemically, using a monoclonal antibody against digoxin. An increase in digitalis-like immunoreactive substances of more than 0·2ng.ml–1in plasma was found in six of 27 patients with non-obstructive hypertrophic cardiomyopathy (22·2%) and five of 13 with obstructive hypertrophic cardiomyopathy (38·4%). Under light microscopy, positive staining against the antibody was observed heterogeneously on some cardiocytes. In non-obstructive hypertrophic cardiomyopathy, digitalis-like immunoreactive substances in the plasma correlated with the left atrial dimension and inversely with the cardiac index. In obstructive hypertrophic cardiomyopathy, plasma and myocardial digitalis-like immunoreactive substances were positively correlated; they also correlated with left ventricular end-diastolic pressures. Under electron microscopy, digitalis-like immunoreactive substances were detected at the sarcolemma in the free wall, T-tubules, intercalated discs and Z-bands of cardiocytes.

Conclusions Increased digitalis-like immunoreactive substances in plasma and cardiocytes, which may have been caused by pressure and/or volume overload, were found in patients with hypertrophic cardiomyopathy. Digitalis-like immunoreactive substances may act on the sarcolemma of cardiocytes and be transported into the cytoplasm.

Key Words: Digitalis-like immunoreactive substances, hypertrophic cardiomyopathy, immunohistochemistry, ultrastructure

f1 Correspondence: Tetsuya Hayashi, MD, PhD, The Third Division, Department of Medicine, Osaka Medical College, 2–7 Daigakumachi, Takatsuki City, Osaka 569-8686, Japan.

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