Distribution of Cardiac Muscle Cell Disorganization in Hearts of Patients with Hypertrophic Cardiomyopathy
Anan, Thomas J.
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Extensive cardiac muscle cell disorganization in the ventricular septum has been found to be a highly specific and sensitive marker of hypertrophic cardiomyopathy. To determine the distribution of this disorganization in other regions of the left ventricular wall, anterior and posterior free wall sections were taken from hearts of 45 patients with hypertrophic cardiomyopathy and from the hearts of 85 control patients, and the area occupied by disorganized cardiac muscle cells was quantitated. Free wall sections were found to have significantly more extensive disorganization in patients with hypertrophic cardiomyopathy than in the control patients (mean 26 ± 3.7% vs. 2 ± 0.5%, p<0;.001). Combined with the ventricular septal findings all three sections revealed the extent of disorganizatlon in the left ventricular wall to be significantly greater in patients with hypertrophic cardiomyopathy than in control patients (mean 29 + 3.2% vs. 2 ± 0.5%, p<0.001). Furthermore, extensive disorganization, involving 5% or more of the left ventricular wall was seen in 82% of the patients with hypertrophic cardiomyopathy compared. with 19% of the control patients (p <0.001) . The most marked degree of left ventricular wall disorganization (mean 4) ± 6.0%) was observed in 15 patients with hypertrophic cardiomyopathy who were less than 25 years old at death and in whom sudden death was the first manifestation of cardiac disease. Hence, extensive cardiac muscle cell disorganization is widely distributed throughout the left ventricular wall of patients With hypertrophic cardiomyopathy and may represent a diffuse cardiomypathlc process in many patients with this disease, particularly young previously asymptomatic patients who die suddenly.