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Infiltration of Conduction Tissue Is a Major Cause of Electrical Instability in Cardiac Amyloidosis

Background: The pathology of conduction tissue (CT) and relative arrhythmias in living subjects with cardiac amyloid have never been reported. Aims: To report CT pathology and its arrhythmic correlations in human cardiac amyloidosis. Methods and Results: In 17 out of 45 cardiac amyloid patients, a l...

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Autores principales: Frustaci, Andrea, Verardo, Romina, Russo, Matteo Antonio, Caldarulo, Marina, Alfarano, Maria, Galea, Nicola, Miraldi, Fabio, Chimenti, Cristina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10003445/
https://www.ncbi.nlm.nih.gov/pubmed/36902585
http://dx.doi.org/10.3390/jcm12051798
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author Frustaci, Andrea
Verardo, Romina
Russo, Matteo Antonio
Caldarulo, Marina
Alfarano, Maria
Galea, Nicola
Miraldi, Fabio
Chimenti, Cristina
author_facet Frustaci, Andrea
Verardo, Romina
Russo, Matteo Antonio
Caldarulo, Marina
Alfarano, Maria
Galea, Nicola
Miraldi, Fabio
Chimenti, Cristina
author_sort Frustaci, Andrea
collection PubMed
description Background: The pathology of conduction tissue (CT) and relative arrhythmias in living subjects with cardiac amyloid have never been reported. Aims: To report CT pathology and its arrhythmic correlations in human cardiac amyloidosis. Methods and Results: In 17 out of 45 cardiac amyloid patients, a left ventricular endomyocardial biopsy included conduction tissue sections. It was identified by Aschoff–Monckeberg histologic criteria and positive immunostaining for HCN4. The degree of conduction tissue infiltration was defined as mild when ≤30%, moderate when 30–70% and severe when >70% cell area was replaced. Conduction tissue infiltration was correlated with ventricular arrhythmias, maximal wall thickness and type of amyloid protein. Mild involvement was observed in five cases, moderate in three and severe in nine. Involvement was associated with a parallel infiltration of conduction tissue artery. Conduction infiltration correlated with the severity of arrhythmias (Spearman rho = 0.8, p < 0.001). In particular, major ventricular tachyarrhythmias requiring pharmacologic treatment or ICD implantation occurred in seven patients with severe, one patient with moderate and none with mild conduction tissue infiltration. Pacemaker implantation was required in three patients, with complete conduction section replacement. No significant correlation was observed between the degree of conduction infiltration and age, cardiac wall thickness or type of amyloid protein. Conclusions: Amyloid-associated cardiac arrhythmias correlate with the extent of conduction tissue infiltration. Its involvement is independent from type and severity of amyloidosis, suggesting a variable affinity of amyloid protein to conduction tissue.
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spelling pubmed-100034452023-03-11 Infiltration of Conduction Tissue Is a Major Cause of Electrical Instability in Cardiac Amyloidosis Frustaci, Andrea Verardo, Romina Russo, Matteo Antonio Caldarulo, Marina Alfarano, Maria Galea, Nicola Miraldi, Fabio Chimenti, Cristina J Clin Med Brief Report Background: The pathology of conduction tissue (CT) and relative arrhythmias in living subjects with cardiac amyloid have never been reported. Aims: To report CT pathology and its arrhythmic correlations in human cardiac amyloidosis. Methods and Results: In 17 out of 45 cardiac amyloid patients, a left ventricular endomyocardial biopsy included conduction tissue sections. It was identified by Aschoff–Monckeberg histologic criteria and positive immunostaining for HCN4. The degree of conduction tissue infiltration was defined as mild when ≤30%, moderate when 30–70% and severe when >70% cell area was replaced. Conduction tissue infiltration was correlated with ventricular arrhythmias, maximal wall thickness and type of amyloid protein. Mild involvement was observed in five cases, moderate in three and severe in nine. Involvement was associated with a parallel infiltration of conduction tissue artery. Conduction infiltration correlated with the severity of arrhythmias (Spearman rho = 0.8, p < 0.001). In particular, major ventricular tachyarrhythmias requiring pharmacologic treatment or ICD implantation occurred in seven patients with severe, one patient with moderate and none with mild conduction tissue infiltration. Pacemaker implantation was required in three patients, with complete conduction section replacement. No significant correlation was observed between the degree of conduction infiltration and age, cardiac wall thickness or type of amyloid protein. Conclusions: Amyloid-associated cardiac arrhythmias correlate with the extent of conduction tissue infiltration. Its involvement is independent from type and severity of amyloidosis, suggesting a variable affinity of amyloid protein to conduction tissue. MDPI 2023-02-23 /pmc/articles/PMC10003445/ /pubmed/36902585 http://dx.doi.org/10.3390/jcm12051798 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Brief Report
Frustaci, Andrea
Verardo, Romina
Russo, Matteo Antonio
Caldarulo, Marina
Alfarano, Maria
Galea, Nicola
Miraldi, Fabio
Chimenti, Cristina
Infiltration of Conduction Tissue Is a Major Cause of Electrical Instability in Cardiac Amyloidosis
title Infiltration of Conduction Tissue Is a Major Cause of Electrical Instability in Cardiac Amyloidosis
title_full Infiltration of Conduction Tissue Is a Major Cause of Electrical Instability in Cardiac Amyloidosis
title_fullStr Infiltration of Conduction Tissue Is a Major Cause of Electrical Instability in Cardiac Amyloidosis
title_full_unstemmed Infiltration of Conduction Tissue Is a Major Cause of Electrical Instability in Cardiac Amyloidosis
title_short Infiltration of Conduction Tissue Is a Major Cause of Electrical Instability in Cardiac Amyloidosis
title_sort infiltration of conduction tissue is a major cause of electrical instability in cardiac amyloidosis
topic Brief Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10003445/
https://www.ncbi.nlm.nih.gov/pubmed/36902585
http://dx.doi.org/10.3390/jcm12051798
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