Type and extent of myocardial injury related to brain damage and its significance in heart transplantation: a morphometric study. NLM AIDSLINE Important note: Information in this article was accurate in 1998. The state of the art may have changed since the publication date.

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Type and extent of myocardial injury related to brain damage and its significance in heart transplantation: a morphometric study.

J Heart Lung Transplant. 1997 Oct;16(10):994-1000. Unique Identifier : AIDSLINE MED/98027133
Baroldi G; Di Pasquale G; Silver MD; Pinelli G; Lusa AM; Fineschi V; Department of Cardiology De Gasperis, Niguarda Hospital,; University of Milan, Italy.

Abstract: BACKGROUND: Focal myocardial necrosis reported in patients who died of brain lesions and in donor hearts soon after insertion has been attributed to catecholamine-related injury induced before operation, or in the perioperative period. Interpretation of the morphofunctional type of myocardial injury observed and its quantification may help understand both its pathophysiology and clinical relevance. METHODS: In 27 patients without heart disease who died of intracranial brain hemorrhage after berry aneurysm rupture, terminal clinical signs were correlated with the presence of absence of myocardial injury. All hearts were systematically examined, and the total histologic area was measured in square millimeters, with both the number of foci and myocardial cells showing necrosis, normalized to 100 mm2. Forty-five cases of fatal head trauma (26 "instantaneous" and 19 "rapid" deaths) in normal subjects and 38 cases of acquired immunodeficiency syndrome with (14 cases) or without (24 cases) severe brain damage were used as control subjects. RESULTS: Contraction band necrosis was the only form of myocardial necrosis found in 89% of patients with acute brain hemorrhage. Its extent was 26 +/- 34 foci and 67 +/- 104 necrotic myocardial cells x 100 mm2. In patients with acquired immunodeficiency syndrome, its frequency was 58% in those without and 78.5% with severe brain lesions, with foci and myocardial cell values of 1 +/- 1.5 and 10 +/- 22 and 7 +/- 16 and 17 +/- 32, respectively. In head trauma cases with instantaneous death, the frequency was 4% (one case only with foci 0.5 and myocardial cells 35), whereas with a rapid death it was 40% (foci 12 +/- 18 and myocardial cells 21 +/- 33). CONCLUSIONS: The observed myocardial injury was present in all groups examined, being maximal in patients with intracranial brain hemorrhage with longer survival and minimal in patients with head trauma who died instantaneously. In this setting, this lesion is typical of catecholamine myotoxicity and may express a sympathetic overstimulation either in the agonal period and independent of therapy or be caused by brain injury, especially intracranial brain hemorrhage. However, the extent of myocardial injury observed was minimal and should not jeopardize cardiac function if hearts from such subjects are transplanted.
Keywords: Acquired Immunodeficiency Syndrome/COMPLICATIONS/PHYSIOPATHOLOGY Adult Age Factors Aged Aneurysm, Ruptured/COMPLICATIONS/PHYSIOPATHOLOGY AIDS Dementia Complex/COMPLICATIONS/PHYSIOPATHOLOGY Brain Abscess/COMPLICATIONS/PHYSIOPATHOLOGY Brain Diseases/*COMPLICATIONS/PHYSIOPATHOLOGY Catecholamines/PHYSIOLOGY Cause of Death Cerebral Aneurysm/COMPLICATIONS/PHYSIOPATHOLOGY Cerebral Hemorrhage/COMPLICATIONS/PHYSIOPATHOLOGY Female Head Injuries/COMPLICATIONS/PHYSIOPATHOLOGY Heart Transplantation/*PATHOLOGY Human Male Meningoencephalitis/COMPLICATIONS/PHYSIOPATHOLOGY Middle Age Myocardial Infarction/ETIOLOGY/PATHOLOGY/PHYSIOPATHOLOGY Myocardial Ischemia/*ETIOLOGY/PATHOLOGY/PHYSIOPATHOLOGY Myocardium/PATHOLOGY Necrosis Organ Weight Sex Factors Support, Non-U.S. Gov't Sympathomimetics/PHARMACOLOGY JOURNAL ARTICLEKWDacquiredimmunodeficiencysyndrome/complications/physiopathologyadultagefactorsagedaneurysm,ruptured/complications/physiopathologyaidsdementiacomplex/complications/physiopathologybrainabscess/complications/physiopathologybraindiseases/KWDcomplications/physiopathologycatecholamines/physiologycauseofdeathcerebralaneurysm/complications/physiopathologycerebralhemorrhage/complications/physiopathologyfemaleheadinjuries/complications/physiopathologyhearttransplantation/KWDpathologyhumanmalemeningoencephalitis/complications/physiopathologymiddleagemyocardialinfarction/etiology/pathology/physiopathologymyocardialischemia/KWDetiology/pathology/physiopathologymyocardium/pathologynecrosisorganweightsexfactorssupport,non-uKWDsKWDgov'tsympathomimetics/pharmacologyjournalarticle
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M9820701

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