RESUMO
The aim of the preliminary study was to evaluate the role of apoptosis and proliferation of myocytes in order to predict the prognosis and optimal treatment of patients with end-stage dilated cardiomyopathy. Endomyocardial biopsy was performed during open-heart surgery (reductive annuloplasty of double orifice) in 19 patients with end-stage dilated cardiomyopathy. The terminal deoxynucleotidyl transferase d-UTP-biotin nick-end labelling (TUNEL) method was used for the detection of apoptosis, and immunohistochemical methods were used for the evaluation of inhibitor of apoptosis such as proto-oncogene Bcl-2 (B-cell lymphoma gene), and proliferative markers such as proliferation cell nuclear antigen (PCNA) and Ki-67 proliferative antigen. The increased percentage of apoptotic myocytes and decreased expression of bcl-2 is associated with earlier death after surgery. Increased expression of proliferation markers of myocytes in patients who survived seven years after surgery compared to those who died within three years suggest that adult cardiomyocytes are not terminally differentiated and this might represent potential growth reserve of the diseased heart. Based on our preliminary study we may conclude that myocytes' apoptosis and proliferative activity might help us to predict the prognosis and optimal treatment of patients with end-stage dilated cardiomyopathy.
Assuntos
Apoptose , Cardiomiopatia Dilatada/patologia , Fibras Musculares Esqueléticas/patologia , Miocárdio/patologia , Adulto , Idoso , Biópsia , Divisão Celular , Feminino , Humanos , Marcação In Situ das Extremidades Cortadas , Masculino , Pessoa de Meia-Idade , Fibras Musculares Esqueléticas/química , Valor Preditivo dos Testes , Prognóstico , Antígeno Nuclear de Célula em Proliferação/análise , Proto-Oncogene MasRESUMO
A patient in whom idiopathic amyloidosis of aortocoronary saphenous vein grafts was found at autopsy two years after myocardial revascularization due to coronary atherosclerosis is reported. Idiopathic generalized immunocyte derived amyloidosis extensively studied at autopsy was obviously present at the time of surgery although it remained unnoticed macroscopically in the inserted graft. It appears that simultaneously with arterialization further deposition and also significant redistribution of amyloid within the walls of the vein grafts additionally took place after their insertion. It seems interesting that in spite of the amyloidosis the grafts functioned well and were found patent two years after surgery.
