Right vs. left ventricular contractile reserve in one-year prognosis of patients with idiopathic dilated cardiomyopathy: assessment by dobutamine stress echocardiography.

AIM: To determine prognostic implications of the assessment of right (RV) vs. left ventricular (LV) contractile reserve with dobutamine echocardiography in patients with idiopathic dilated cardiomyopathy. METHODS AND RESULTS: Forty-eight consecutive patients (41 male, NYHA class III/IV 13 patients, LV ejection fraction 19+/-8%) were subjected to dobutamine stress echocardiography in incremental stages lasting 5 min each. Contractile reserve was defined as the difference between the values of LV ejection fraction and RV fractional area change obtained at peak dobutamine dose and the baseline values. Patients were followed for one year after enrollment for combined end-point of cardiac death, partial left ventriculectomy and hospitalization for congestive heart failure. During the follow-up 15/48 patients reached combined end-point. Patients who reached end-point had lower RV and LV contractile reserves (14+/-5 vs. 8+/-6%, p=0.0014, and 9+/-5 vs. 3+/-2%, p<0.001, respectively). Kaplan-Meier curves demonstrated that both LV and RV contractile reserves can identify patients with dismal prognosis (log rank=17.02 and log rank=14.66, respectively, p<0.001 for both). Multivariate analysis identified dobutamine induced change in LV functional reserve as the only independent predictor of combined end-point (beta=-0.63, p=0.0035). CONCLUSION: Both RV and LV contractile reserves can be used for prognostic stratification in patients with idiopathic dilated cardiomyopathy. It appears that dobutamine induced change in LV functional reserve may better identify patients with dismal prognosis.

Semiquantitative histomorphometric analysis of myocardium following partial left ventriculectomy: 1-year follow-up.

BACKGROUND: Although partial left ventriculectomy (PLV) may have beneficial clinical effects in patients with dilated cardiomyopathy (DCM), there are no reports on effects of PLV on myocardial histology. The objective of this study was to assess histological properties of the LV myocardium 1 year following PLV as compared to histology at the time of the operation. METHODS: The study group consisted of 15 consecutive PLV survivors, predominantly male (13/15), aged 45+/-12 years. Surgical specimens and endomyocardial biopsies, taken 12 months postoperatively, were processed routinely and stained with Masson-trichrome. The following morphometric parameters were assessed semiquantitavely: (1) degree of hypertrophy and attenuation; (2) nuclear evidence of hypertrophy; (3) myofibrillar volume fraction; (4) degree of degenerative vacuolar changes; and (5) fibrosis volume fraction. RESULTS: Both New York Heart Association (NYHA) functional class and ejection fraction (EF) improved 12 months following surgery as compared to preoperative values (2.40+/-0.69 vs. 3.33+/-0.49, p<0.001, and 33.21+/-12.05% vs. 20.21+/-9.07%, p<0.001, respectively). Morphometric analysis demonstrated postoperative decrease in the degree of attenuation as compared to preoperative values (1.40+/-0.51 vs. 2.47+/-0.64, p<0.01), as well as a decrease in fibrosis volume fraction (2.07+/-0.80 vs. 2.67+/-0.49, p<0.001) and nuclear hypertrophy (1.27+/-0.46 vs. 1.67+/-0.62, p<0.05). On the other hand, postoperative increase in myofibrillar volume fraction (1.87+/-0.61 vs. 1.40+/-0.61, p<0.01) was noted. CONCLUSION: One year postoperatively, PLV has favourable effects on myocardial morphology that parallels improvement in the patient's functional status and LV systolic function.

Relation of myocardial histomorphometric features and left ventricular contractile reserve assessed by high-dose dobutamine stress echocardiography in patients with idiopathic dilated cardiomyopathy.

BACKGROUND: This study was designed to determine the relationship between histomorphometric features and contractile reserve assessed by high-dose dobutamine stress echocardiography in patients with idiopathic dilated cardiomyopathy. METHODS: Twenty-four consecutive patients (21 men, aged 43.4+/-8.7 years) with idiopathic dilated cardiomyopathy underwent dobutamine stress echocardiography. Wall motion score index, ejection fraction, cardiac power output and end-systolic pressure/volume ratio were used as indices of left ventricular contractility. Left ventricular endomyocardial biopsy specimens (3-5 per patient) were routinely processed and stained with Masson trichrome, interstitial fibrosis and myocyte diameter were calculated quantitatively. RESULTS: Myocyte diameter and interstitial fibrosis showed strongest correlation with change in wall motion score index (r=-0.667, p<0.001, and r=-0.567, p=0.004, respectively), followed by change in ejection fraction (r=-0.603, p=0.002, and r=-0.467, p=0.021, respectively). Interstitial fibrosis showed no correlation with change of cardiac power output and end-systolic pressure/volume ratio, whereas myocyte diameter was associated with change of both indices (r=-0.565, p=0.004, and r=-0.455, p=0.025). CONCLUSIONS: Contractile reserve elicited by high-dose dobutamine is strongly related to the degree of histological disruption in patients with idiopathic dilated cardiomyopathy.

A well-differentiated liposarcoma co-existent with leiomyoma.

BACKGROUND: The coexistence of a well-differentiated liposarcoma (atypical lipomatous tumor) and benign smooth muscle component in a single soft tissue neoplasm is extremely rare. CASE REPORT: Histologic and immunohistochemical characteristics of tumor, which represented the recurrence of a retroperitoneal atypical lipoma in a 50-year-old female patient are presented in this paper. The tumor represented the recurrence of a retroperitoneal atypical lipoma. Lipomatous component consisted of a mixture of lipoma-like and sclerosing variant of well-differentiated liposarcoma. Characteristically, the heterologous smooth muscle differentiation was manifested as a macroscopically visible nodular growth in the form of a leiomyoma within the adipocytic component. It consisted of intersecting fascicles of spindle cells, which lacked mitoses and significant atypia, and were immunopositive for smooth muscle markers. CONCLUSION: This case of well-differentiated liposarcoma with benign smooth muscle is the first reported tumor of retroperitoneal localization. It is also the first one to exhibit the heterologous smooth muscle component as a distinct leiomyoma.