TY - JOUR
T1 - Evidence for an active inflammatory process in the hibernating human myocardium
AU - Frangogiannis, Nikolaos G.
AU - Shimoni, Sarah
AU - Chang, Su Min
AU - Ren, Guofeng
AU - Shan, Kesavan
AU - Aggeli, Constandina
AU - Reardon, Michael J.
AU - Letsou, George V.
AU - Espada, Rafael
AU - Ramchandani, Mahesh
AU - Entman, Mark L.
AU - Zoghbi, William A.
N1 - Funding Information:
Supported by the National Institutes of Health (grant HL-42550 to M. L. E. and N. G. F.), the DeBakey Heart Center, the John S. Dunn, Sr., Trust Fund (to W. A. Z.), and the Methodist Hospital Foundation (to N. G. F.).
PY - 2002
Y1 - 2002
N2 - Myocardial hibernation refers to a state of prolonged impairment of left ventricular function in the presence of coronary artery disease, which may be reversed by revascularization. In this study we present evidence for a local inflammatory reaction in hibernating myocardial segments from patients undergoing coronary revascularization. We obtained transmural myocardial biopsies guided by transesophageal echocardiography from patients with ischemic ventricular dysfunction undergoing bypass surgery. Among the 28 biopsied segments included in the study, 23 showed evidence of systolic dysfunction. The majority of dysfunctional segments (85.7%) were viable (201Tl uptake ≥ 60%). The samples were stained with markers for mast cells, mature resident macrophages, and the monoclonal antibody Mac387 that labels newly recruited myeloid cells. Dysfunctional segments showed more extensive fibrosis and higher macrophage density than normal segments. Among the 23 dysfunctional segments, 12 recovered function as assessed with echocardiograms 3 months after revascularization. Segments with postoperative functional recovery had comparable macrophage and mast cell density with those showing persistent dysfunction. However, biopsied segments that subsequently recovered function contained significantly higher numbers of newly recruited Mac387-positive leukocytes (18.7 ± 3.1 cells/mm2, n = 12 versus 8.6 ± 0.9 cells/mm2, n = 11; P = 0.009). In addition, monocyte chemotactic protein-1, a potent mononuclear cell chemoattractant, was predominantly expressed in segments with recovery of function. Myocardial hibernation is associated with an inflammatory response leading to active leukocyte recruitment. Dysfunctional myocardial segments that show an active inflammatory reaction have a greater potential for recovery of function after revascularization. We postulate that revascularization may promote resolution of the ongoing inflammation, preventing further tissue injury and fibrosis.
AB - Myocardial hibernation refers to a state of prolonged impairment of left ventricular function in the presence of coronary artery disease, which may be reversed by revascularization. In this study we present evidence for a local inflammatory reaction in hibernating myocardial segments from patients undergoing coronary revascularization. We obtained transmural myocardial biopsies guided by transesophageal echocardiography from patients with ischemic ventricular dysfunction undergoing bypass surgery. Among the 28 biopsied segments included in the study, 23 showed evidence of systolic dysfunction. The majority of dysfunctional segments (85.7%) were viable (201Tl uptake ≥ 60%). The samples were stained with markers for mast cells, mature resident macrophages, and the monoclonal antibody Mac387 that labels newly recruited myeloid cells. Dysfunctional segments showed more extensive fibrosis and higher macrophage density than normal segments. Among the 23 dysfunctional segments, 12 recovered function as assessed with echocardiograms 3 months after revascularization. Segments with postoperative functional recovery had comparable macrophage and mast cell density with those showing persistent dysfunction. However, biopsied segments that subsequently recovered function contained significantly higher numbers of newly recruited Mac387-positive leukocytes (18.7 ± 3.1 cells/mm2, n = 12 versus 8.6 ± 0.9 cells/mm2, n = 11; P = 0.009). In addition, monocyte chemotactic protein-1, a potent mononuclear cell chemoattractant, was predominantly expressed in segments with recovery of function. Myocardial hibernation is associated with an inflammatory response leading to active leukocyte recruitment. Dysfunctional myocardial segments that show an active inflammatory reaction have a greater potential for recovery of function after revascularization. We postulate that revascularization may promote resolution of the ongoing inflammation, preventing further tissue injury and fibrosis.
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U2 - 10.1016/S0002-9440(10)62568-0
DO - 10.1016/S0002-9440(10)62568-0
M3 - Article
C2 - 11943726
AN - SCOPUS:0036102987
SN - 0002-9440
VL - 160
SP - 1425
EP - 1433
JO - American Journal of Pathology
JF - American Journal of Pathology
IS - 4
ER -