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European Heart Journal Advance Access published online on May 25, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi342
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European Heart Journal © The European Society of Cardiology 2005; All rights reserved
Received December 8, 2004
Revised April 23, 2005
Accepted April 28, 2005

Clinical research

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

Alessandra Repetto 1, Barbara Dal Bello 2, Michele Pasotti 1, Manuela Agozzino 2, Mario Viganò 3, Catherine Klersy 4, Luigi Tavazzi 1, and Eloisa Arbustini 2*

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

* To whom correspondence should be addressed.
Eloisa Arbustini, E-mail: e.arbustini{at}smatteo.pv.it


  Abstract

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.

Keywords: Idiopathic dilated cardiomyopathy (IDCM); Heart transplantation (HTx); Atherosclerosis; Risk factors.
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