Quantitative Analysis Of Myocardial Histopathological Features In Patients With Alcoholic Cardiomyopathy

Objection:Alcoholic cardiomyopathy(ACM),a type of DCM,is caused by long-term consumption of excess alcohol.The differentiation of ACM from idiopathic dilated cardiomyopathy(IDCM)is difficult due to the absence of specific clinical characteristics and immunological biomarkers.The present study aimed to identify the quantitative pathological features of ACM compared to that in IDCM hearts.Methods:From June 2004 to June 2015,we collected data and cardiac tissue samples from 500 patients who underwent heart transplantation at the Heart Transplantation Center of Fuwai Hospital.Among them,280 cases presented with left ventricle dilation.All these patients were interviewed telephonically to evaluate their alcohol consumption by a questionnaire on which they reported their beverage intake before clinical diagnosis.We enrolled patients according to the fulfilled diagnostic criterias of IDCM and ACM.Specimens from six regions were sampled from each resected disease heart,including anterior left ventricle(LV),lateral LV,inferior LV,interventricular septum,anterior right ventricle(RV),inferior RV.Samples obtained from 24 healthy donors were also chosen.Their hearts were un-useful for transplantation due to blood-type incompatibility or other surgical reasons.These individuals died because of cerebrovascular or motor vehicle accident.In control group,full-thickness samples were obtained from two regions including left free ventricle wall and right free ventricle wall.Tissues were sectioned and Masson's trichrome stained,sequentially.Histological analysis was performed using dedicated software(Adobe Photoshop CS5 and Image-Pro Plus 6.0,Media Cybernetics,MD,USA).Results:408 specimens were obtained from 68 patients,including 34 ACMs and 34 IDCMs,age-and sex-matched.We found a statistically significant difference in the percentage area of myocyte and interstitium between ACM and IDCM(69.50±8.70%vs.71.94±7.39%,p<0.05;10.76±4.78%vs.9.20±6.16%,p<0.05;respectively).Next,we assessed the hypothesis that if these differences were consistent between LV and RV.Based on measures related to cumulative three LV sampling sites,we detected a significant reduction of the myocyte area in ACM compared to that in IDCM(65.37±11.83%vs.70.03±9.02%,p=0.009).Compared to IDCM,a higher percentage area of fatty tissue could be observed in ACM(5.17±6.51%vs.4.27±4.98%,p=0.026).However,based on measures related to cumulative two RV sites,we found no differences in tissue parameters of myocyte,fibrosis,fatty tissue and interstitium between ACM and IDCM.Samples were obtained from six regions in the myocardium of diseased hearts,so there might be regional heterogeneity of histological changes.Thus,we compared the histological data between ACM and IDCM site-by-site.In the site of anterior LV,we discovered that the myocyte area differed significantly between ACM and IDCM(65.51±14.00%vs.72.70±10.43%,p=0.019);no statistically significant difference was detected in tissue parameters of fibrosis,fatty tissue and interstitium.In other five sampling sites,the histological parameters(myocyte,fibrosis,fatty tissue,and interstitium)were identified as displaying no statistical significance.A number of 48 control specimens were obtained from 24 healthy donors.In normal heart tissues,the cumulative amount of myocyte was 84.47±4.23%,of fibrosis was 4.14±2.11%,of fatty tissue was 3.99±3.11%,and of interstitium was 7.40±3.00%.Compared to normal heart tissues,we observed an increase in fibrosis and interstitium,which replaces myocytes in heart tissue of cardiomyopathy disease.Conclusion:Compared to IDCM,the myocyte loss was a dominating feature in the myocardium of ACM.The LV was preferentially involved,especially the anterior LV.Objection:The differentiation of idiopathic forms of cardiomyopathy from those secondary to alcohol seems to have important prognostic and therapeutic implications.The clinical outcome of alcoholic cardiomyopathy could be better than that of idiopathic dilated cardiomyopathy if patients abstained from alcohol,at least in the early stages of the disease.The aim of the present study was,therefore,to investigate the long-term outcome of patients with signs and symptoms of overt heart failure due to alcoholic dilated cardiomyopathy and to compare it to that of patients with similar degrees of congestive heart failure due to idiopathic cardiomyopathy.Methods:The records of 280 cases underwent cardiac transplantation from December 2004 through June 2015 at Fuwai Hospital were retrospectively reviewed.We compared and analyzed their differences of disease progression and mortality after heart transplantation between alcoholic cardiomyopathy(ACM)and idiopathic dilated cardiomyopathy(IDCM)by KaplanMeier(K-M)method.Results:A total of 280 patients were enrolled in our study.According to pre-transplantation diagnosis,41 cases(15%)were ischemic heart disease;34 cases(12%)were alcoholic heart disease;25 cases(9%)were hypertensive heart disease;19 cases(7%)were inflammative heart disease;6 cases(2%)were end-stage hypertrophic heart disease;5 cases(2%)were valvular heart disease;3 cases(1%)were left ventricle non-compation heart disease;2 cases(1%)were right ventricle arrythimic heart disease;1 cases was congenital heart disease.144 patients were considered as IDCM(age<18 years in 11 cases).Except age,sex,total bilirubin,blood urea nitrogen(BUN),no statistically significant difference was observed in clinical,laboratory examination,echocardiographic data between alcoholic cardiomyopathy(ACM)and idiopathic dilated cardiomyopathy(IDCM).The time interval of disease dignosis to heart transplantation was 6.0±4.2 year in idiopathic cardiomyopathy;7.3±4.0 year in alcoholic cardiomyopathy.Disease progression in alcoholic dilated cardiomyopathy is no different from that in idiopathic cardiomyopathy.The mean follow up time after heart transplantation was 1444.08±927.77 days in idiopathic cardiomyopathy,nine patients died.The mean fellow up time after heart transplantation was 2450.24±800.54 days in alcoholic cardiomyopathy,no patient died.Long-term actuarial recipient survival was observed no significant difference between alcoholic cardiomyopathy and idiopathic dilated cardiomyopathy.Comclusion:Patients with alcoholic cardiomyopathy did not have a better outcome than patients with idiopathic dilated cardiomyopathy.After receiving heart transplantation,there was no better survival rate in ACM patients than in IDCM patients.