Clinical Variables Associated With the Presence of Inflammatory
Infiltrates in Patients With Dilated Cardiomyopathy Undergoing
Heart Transplantation
J. Agüero, J. Navarro, M.C. Medina, L. Almenar, M. Chirivella, L. Martı´nez-Dolz, J.A. Moro,
I. Sánchez-Lazaro, V. Ortiz, R. Raso, and A. Salvador
ABSTRACT
Introduction. Idiopathic dilated cardiomyopathy (DCM) is, together with ischemic heart
disease, the major cause of end-stage heart failure leading to heart transplantation.
However, an unknown percentage of patients with this diagnosis has inflammatory foci
found in the histopathological study of the explanted heart. This fact suggests an
undetected process of acute myocarditis as the cause of cardiac dysfunction.
Objective. The objective of this study was to identify clinical and echocardiographic
variables related to the presence of myocardial infiltrates, as a potential guide to determine
which patients should undergo endomyocardial biopsy in DCM.
Materials and Methods. We retrospectively analyzed 161 patients who underwent heart
transplantation with a diagnosis of DCM between 1987 and 2007. The presence of
inflammatory infiltrates was considered significant when the histopathological study of
tissue blocks from the left ventricle showed 1 or more foci per cm
2
of perivascular or
interstitial mononuclear or polymorphonuclear cells, whether or not in the presence of
cytolysis.
Results. Seventeen patients (11%) had these inflammatory histological findings; of them,
6 (35%) showed preponderance of eosinophils and 7 (41%) showed areas of cytolysis. The
DCM group with inflammatory infiltrates showed significant differences in terms of
younger age (45 15 vs 50 11 years; P .01) and smaller ventricular diameters (P
.05). Male gender was more frequent in this group, and the patients had a poorer clinical
status and greater dependence on inotropic drugs.
Conclusions. Inflammatory infiltrates are frequently present in DCM explanted hearts.
Although there are no relevant clinical variables to identify subclinical myocarditis, these
patients are younger and have smaller ventricular diameters and poorer functional status
at the time of transplantation.
D
ILATED cardiomyopathy (DCM) is a frequent cause
of heart failure, and it is the main diagnosis in
patients undergoing heart transplantation. It is referred to
as idiopathic DCM when the cause is undetected. His-
topathological study of idiopathic DCM in biopsy and
explant samples has shown hypertrophy of myocytes and
fibrosis, along with a variable presence of inflammatory
infiltrates.
1
Much evidence links the course of acute myo-
carditis with DCM,
2
although the difficulty of clinical diag-
nosis often prevents its identification in the acute phase.
The low yield of the Dallas Criteria and the negative results
of trials with immunosuppressive drugs
3
led clinicians to
question the utility of endomyocardial biopsies in patients
with DCM. Recent studies concerning the immunohistolog-
ical diagnosis
4
have rekindled the interest in diagnosis of an
From the Heart Failure and Transplant Unit, Department of
Cardiology (J.A., J.N., L.A., L.M.-D., J.A.M., I.S.-L., V.O., R.R.,
A.S.), and Department of Pathology (M.C.M., M.C.), La Fe
University Hospital, Valencia, Spain.
Address reprint requests to Jaime Agüero, Avd. Francia 2-25,
46023 Valencia, Spain. E-mail: jaimeaguero30@hotmail.com
© 2008 by Elsevier Inc. All rights reserved. 0041-1345/08/$–see front matter
360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2008.09.010
Transplantation Proceedings, 40, 3017–3019 (2008) 3017