Document Detail

Evidence for an active inflammatory process in the hibernating human myocardium.
MedLine Citation:
PMID:  11943726     Owner:  NLM     Status:  MEDLINE    
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 ((201)Tl 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/mm(2), n = 12 versus 8.6 +/- 0.9 cells/mm(2), 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.
Nikolaos G Frangogiannis; Sarah Shimoni; Su Min Chang; Guofeng Ren; Kesavan Shan; Constandina Aggeli; Michael J Reardon; George V Letsou; Rafael Espada; Mahesh Ramchandani; Mark L Entman; William A Zoghbi
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The American journal of pathology     Volume:  160     ISSN:  0002-9440     ISO Abbreviation:  Am. J. Pathol.     Publication Date:  2002 Apr 
Date Detail:
Created Date:  2002-04-10     Completed Date:  2002-05-01     Revised Date:  2013-06-09    
Medline Journal Info:
Nlm Unique ID:  0370502     Medline TA:  Am J Pathol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1425-33     Citation Subset:  AIM; IM    
Department of Medicine, Baylor College of Medicine, the Methodist Hospital, Houston, Texas 77030, USA.
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MeSH Terms
Antibodies, Monoclonal
Cell Count
Collagen / metabolism
Heart / physiopathology
Macrophages / pathology
Mast Cells / pathology
Middle Aged
Monocytes / physiology
Myocardial Stunning / pathology*,  physiopathology
Myocarditis / pathology*,  physiopathology
Recovery of Function
Staining and Labeling
Grant Support
Reg. No./Substance:
0/Antibodies, Monoclonal; 9007-34-5/Collagen

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