Abstract: Background: Pathology of conduction tissue (CT) and relative arrhythmias in living subjects with cardiac amyloid have never been reported. Aims: Reporting 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 5 cases, moderate in 3 and severe in 9. Involvement was associated with a parallel infiltration of conduction tissue artery. Conduction infiltration correlated with severity of arrhythmias (Spearman rho=0.8, p <0.001). In particular, major ventricular tachyarrhythmias requiring pharmacologic treatment or ICD implantation occurred in 7 patients with severe, 1 patient with moderate and none with mild conduction tissue infiltration. Pacemaker implantation was required in 3 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. Conclusion: Amyloid-associated cardiac arrhythmias correlate with 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.

Infiltration of conduction tissue is a major cause of electrical instability in cardiac amyloidosis / Frustaci, Andrea; Verardo, Romina Annita; Russo, Matteo Antonio; Caldarulo, Marina; Alfarano, Maria; Galea, Nicola; Miraldi, Fabio; Chimenti, Cristina. - In: JOURNAL OF CLINICAL MEDICINE. - ISSN 2077-0383. - 12:5(2023), p. 1. [10.3390/jcm12051798]

Infiltration of conduction tissue is a major cause of electrical instability in cardiac amyloidosis

Andrea Frustaci
Primo
;
Romina Verardo
Secondo
;
Matteo Antonio Russo;Maria Alfarano;Nicola Galea;Fabio Miraldi
Penultimo
;
Cristina Chimenti
Ultimo
2023

Abstract

Abstract: Background: Pathology of conduction tissue (CT) and relative arrhythmias in living subjects with cardiac amyloid have never been reported. Aims: Reporting 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 5 cases, moderate in 3 and severe in 9. Involvement was associated with a parallel infiltration of conduction tissue artery. Conduction infiltration correlated with severity of arrhythmias (Spearman rho=0.8, p <0.001). In particular, major ventricular tachyarrhythmias requiring pharmacologic treatment or ICD implantation occurred in 7 patients with severe, 1 patient with moderate and none with mild conduction tissue infiltration. Pacemaker implantation was required in 3 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. Conclusion: Amyloid-associated cardiac arrhythmias correlate with 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.
2023
conduction tissue; cardiac amyloid; arrhythmias
01 Pubblicazione su rivista::01a Articolo in rivista
Infiltration of conduction tissue is a major cause of electrical instability in cardiac amyloidosis / Frustaci, Andrea; Verardo, Romina Annita; Russo, Matteo Antonio; Caldarulo, Marina; Alfarano, Maria; Galea, Nicola; Miraldi, Fabio; Chimenti, Cristina. - In: JOURNAL OF CLINICAL MEDICINE. - ISSN 2077-0383. - 12:5(2023), p. 1. [10.3390/jcm12051798]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1672321
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