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Comparative Study
. 1999 Sep;82(3):279-85.
doi: 10.1136/hrt.82.3.279.

Different microcirculatory and interstitial matrix patterns in idiopathic dilated cardiomyopathy and Chagas' disease: a three dimensional confocal microscopy study

M L Higuchi  1 , S Fukasawa, T De Brito, L C Parzianello, G Bellotti, J A Ramires
Affiliations
Comparative Study

Different microcirculatory and interstitial matrix patterns in idiopathic dilated cardiomyopathy and Chagas' disease: a three dimensional confocal microscopy study

M L Higuchi et al. Heart. 1999 Sep.

Abstract

Objective: To analyse the morphological aspects of the extracellular matrix and microcirculation to clarify whether chronic Chagas' cardiopathy (CCC) is an accurate model to study the pathogenesis of idiopathic dilated cardiomyopathy (IDCM).

Design: Thick histological myocardial sections were prepared to analyse collagen, and microcirculation was examined during confocal laser and light microscopy.

Setting: The specimens were prepared at the pathology service of the Heart Institute of São Paulo, Brazil.

Patients: Nine control hearts, eight IDCM hearts, and 10 CCC hearts were studied after necropsy.

Main outcome measures: The number of collagen struts per 100x field, the area of fibrosis (%), and the diameters of arterioles and capillaries were measured in each heart to establish outcome.

Results: A smaller number (mean (SD)) of collagen struts was seen in the hearts in the IDCM group (9.1 (4.1)) than in the control (22.4 (3.2)) (p < 0.05) or CCC (15.7 (7.4)) (p > 0.05) groups. Fibrosis was greater in the CCC hearts (13.8 (10.5)%) than in the IDCM hearts (5.9 (6.6)%) (p > 0.05). Major increases in arteriole (65.4 (9.9) microm) and capillary (9.9 (1.7) microm) diameters were seen in the CCC hearts but not in the IDCM hearts (arteriole diameter 40.3 (7.9) microm; capillary diameter 7.9 (1.3) microm).

Conclusions: Hearts demonstrating CCC and IDCM present different extracellular and microvessel alterations. This suggests that distinct pathogenic mechanisms are responsible for each condition and that CCC is not an effective model to study IDCM.

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Figures

Figure 1
Figure 1
Microscopic fields of extracellular matrix in normal (A, D), IDCM (B, E) and CCC (C, F) hearts. The frames illustrate myocardium stained by the Hortega technique in a 200× microscopic field (A, B, C), and with sirius red and examined by confocal laser microscopy (D, E, F). Note the microscopic field of: (A) normal myocardium with the presence of several struts (arrows); (B) IDCM myocardium exhibiting scarce and fragmented struts (arrows) and foci of fibrosis in pink; (C) CCC myocardium exhibiting severe and diffuse fibrosis in pink enveloping the myocytes as well as some thickened struts (arrows); (D) normal myocardium exhibiting myocytes interlinked by thin collagen struts (arrow) and the arteriole running parallel to the myocytes (arrow heads); (E) IDCM myocardium showing non-compacted perivascular fibrosis; (F) CCC myocardium exhibiting severe fibrosis surrounding individual or groups of hypertrophic myocytes, with capillaries (head of arrows) distorted in the areas of fibrosis and the presence of thickened struts (arrow).
Figure 2
Figure 2
Microscopic appearance of the myocardial microcirculation in normal hearts, CCC hearts, and IDCM hearts. The 40 µm thick myocardial sections of hearts with microvessels perfused with silver solution (64×) are shown in A, B, and C: (A) normal myocardial microvessels; (B) CCC myocardium exhibiting dilated arterioles and an increased number of capillaries; (C) IDCM myocardium showing straightened arterioles and normal capillary vascularisation. Note also (D) Masson-stained CCC myocardium exhibiting diffuse fibrosis and dilated microvessels with thin and fibrotic walls. E, F, and G demonstrate corresponding reflected confocal laser microscopy views seen in A, B, and C: (E) normal microcirculation; (F) CCC microcirculation; (G) IDCM microcirculation. (H) Masson stained IDCM myocardium presenting well delimited foci of fibrosis adjacent to a non-fibrotic area of myocardium without dilated microvessels.
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