Cardiomyocyte desmin abnormalities - an accurate predictor of long-term survival in patients with chronic heart failure.

ABSTRACT

BACKGROUND: The proteins of cardiomyocytes are interesting targets for investigations as they may directly reflect intracellular changes within the heart. Desmin is one of the fundamental cytoskeleton proteins of cardiomyocytes, and has a mechanical, structural and regulatory function. In comparison with healthy individuals, patients with heart failure (HF) present different expression of desmin content, that can be associated with its abnormal structure, different distribution, localisation and disturbed function. Abnormal expression of desmin in cardiomyocytes plays a key role in progression of HF. AIM: To evaluate desmin expression in cardiomyocytes of patients with HF and to asses it's prognostic value during long-term follow-up. METHODS: Diagnostic endomyocardial biopsy (DMB) was performed in 135 patients (86.7% males, mean age 49.4 +/- 14.1 years) with clinical symptoms of HF (left ventricular ejection fraction %lt 45%). In each case four specimens were taken from the right ventricle. Desmin was detected with immunohistochemical staining of cardiomyocytes. The study population was divided into three groups group I - 48 patients with normal expression of desmin; group II - 54 patients with abnormal accumulation of desmin; group III - 33 patients with low expression of desmin in cardiomyocytes. The ROC curves and Kaplan-Meier survival curves were constructed to analyse predictive value of examined parameters. RESULTS: The mean duration of follow-up was 33.2 +/- 14.6 (6-72) months. Cardiac cause of death was confirmed in 2.08% of cases in group I, 7.4% in group II and 22.86% in group III. Group I vs. group II Cox's F test - p = 0.07647; log-rank test - p = 0.15047, group I vs. group III Cox's F test - p = 0.007, log-rank test - p = 0.005, group II vs. group III Cox's F test - p = 0.033, log-rank test - p = 0.079. CONCLUSIONS: Our results suggest that desmin content in cardiomyocytes directly affects the long-term prognosis in HF patients. The low expression of desmin in cardiomyocytes with immunohistochemical assay is associated with unfavourable clinical course.