PMID- 19502086
OWN - NLM
STAT- MEDLINE
DCOM- 20101014
LR  - 20111117
IS  - 1879-1336 (Electronic)
IS  - 1054-8807 (Linking)
VI  - 19
IP  - 4
DP  - 2010 Jul-Aug
TI  - Utility of immunofluorescence and electron microscopy in endomyocardial biopsies 
      from patients with unexplained heart failure.
PG  - e99-105
LID - 10.1016/j.carpath.2009.04.004 [doi]
AB  - BACKGROUND: With our increasing understanding of inflammatory heart disease, the 
      relevance of Dallas criteria has come into question. Immunofluorescence (IF) and 
      electron microscopy (EM) can potentially identify immune reactants and 
      ultrastructural changes not visible by light microscopy (LM), particularly in 
      cases not meeting Dallas criteria. METHODS: This was a retrospective, descriptive 
      study of native endomyocardial biopsies (MBx) performed 1981 to 2006, undertaken 
      to assess the utility of these methods. All patients had decreased cardiac 
      function but normal coronary angiographic studies. LM identified cases as 
      myocarditis (Dallas+), borderline myocarditis (Dallas+/-), or cardiomyopathy 
      (Dallas-). IF studies (human leukocyte antigen (HLA)-DR, IgG, IgM, IgA, C3d, C1q, 
      and fibrinogen) reported interstitial, capillary, or heart-reactive, 
      antibody-like staining patterns. EM findings were also reviewed. RESULTS: Of 472 
      records from 429 patients (6 months-78 years old), 44 were Dallas+, 47 Dallas+/-, 
      and 381 Dallas-. Significant IF and/or EM findings were identified in 421 cases 
      (89%). By IF, 142 (37%) Dallas- cases had significant capillary HLA-DR 
      expression. Thirty-four of 37 cases with vascular immune complex deposition were 
      Dallas-. LM commonly failed to detect myofilament loss (138 cases) and 
      endothelial cell changes (126 cases) that were observed by EM. CONCLUSIONS: IF is 
      a useful strategy for defining inflammatory phenomenon as it revealed significant 
      immune-related heart disease not demonstrable by LM. EM better defined 
      myofilament loss, a finding previously found to be associated with adverse 
      clinical outcome. We strongly recommend that a portion of tissue obtained from 
      all MBx be routinely frozen for IF and fixed appropriately for EM studies. Future 
      studies characterizing the inflammatory molecular profile of myocardial tissues 
      may better define myocarditis.
FAU - She, Rosemary C
AU  - She RC
AD  - Department of Pathology, University of Utah School of Medicine, Salt Lake City, 
      UT, USA. rosemary.she-bender@hsc.utah.edu
FAU - Hammond, Elizabeth H
AU  - Hammond EH
LA  - eng
PT  - Journal Article
DEP - 20090606
PL  - United States
TA  - Cardiovasc Pathol
JT  - Cardiovascular pathology : the official journal of the Society for Cardiovascular 
      Pathology
JID - 9212060
RN  - 0 (Antigen-Antibody Complex)
RN  - 0 (HLA-DR Antigens)
SB  - IM
MH  - Actin Cytoskeleton/pathology/ultrastructure
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Antigen-Antibody Complex/metabolism
MH  - Biopsy
MH  - Capillaries/metabolism/ultrastructure
MH  - Child
MH  - Child, Preschool
MH  - Coronary Angiography
MH  - Endocardium/*pathology/physiopathology
MH  - Female
MH  - HLA-DR Antigens/metabolism
MH  - Heart Failure/etiology/*pathology/physiopathology
MH  - Humans
MH  - Infant
MH  - Microscopy, Electron, Transmission/*methods
MH  - Microscopy, Fluorescence/*methods
MH  - Middle Aged
MH  - Myocarditis/complications/*pathology/physiopathology
MH  - Retrospective Studies
MH  - Young Adult
EDAT- 2009/06/09 09:00
MHDA- 2010/10/15 06:00
CRDT- 2009/06/09 09:00
PHST- 2008/08/11 00:00 [received]
PHST- 2009/03/07 00:00 [revised]
PHST- 2009/04/14 00:00 [accepted]
PHST- 2009/06/09 09:00 [entrez]
PHST- 2009/06/09 09:00 [pubmed]
PHST- 2010/10/15 06:00 [medline]
AID - S1054-8807(09)00036-2 [pii]
AID - 10.1016/j.carpath.2009.04.004 [doi]
PST - ppublish
SO  - Cardiovasc Pathol. 2010 Jul-Aug;19(4):e99-105. doi: 
      10.1016/j.carpath.2009.04.004. Epub 2009 Jun 6.