Diagnostic Usefulness of Histological Examination of the Left Ventricular "Core" Excised to Insert a Left Ventricular Assist Device in Patients With Severe Heart Failure.

The left ventricular assist device (LVAD) has proven to be beneficial for patients with severe heart failure poorly responsive to anti heart failure medicine. To examine both grossly and histologically the portion of left ventricular (LV) free wall excised ("the left ventricular core") to insert a LVAD in 337 patients with severe heart failure from a variety of causes. We collected together all photographs of LV "cores" and the histologic sections prepared from them and reexamined both. Despite the fact that these LV cores usually weighed >100 times the quantity of myocardium available to examine compared with that available by biotome inserted via a transvenous catheter, the number in which histologic study allowed an unequivocal diagnosis was limited. Examination of the clinical records usually was required to establish the definitive diagnosis. Although the presence of a scarred myocardial wall usually suggested ischemic cardiomyopathy (IC), the scarring may not have involved the LV apex resulting in a nonscarred portion of myocardium simulating idiopathic dilated cardiomyopathy (IDC). Moreover, about 10% of the patients with IDC have myocardial scars thus simulating IC. Involvement of the LV core by amyloid, sarcoid, myocarditis, and acute infarction, of course, allowed a specific anatomic diagnosis. Despite the presence of ample tissue to secure a definitive diagnosis, the combination of clinical input and morphologic assessment was required to arrive at a definite diagnosis in most patients.

Causes of Death and Heart Weights in Adults at Necropsy in a Tertiary Texas Hospital, 2013-2015.

The causes of death and heart weights at death appear to be quite different in the USA today than in the first few decades of the last century. We determined the causes of death and heart weights at necropsy in 231 adults and compared the heart weights to those reported in several studies in the first half of the 20th century. Of the 231 patients, 91 (39%) died of a cardiovascular (CV) condition, and 140 (61%), of a non-CV condition. Of the 91 fatal CV disease cases, 48 had fatal coronary artery disease (CAD); of the remaining 183 cases without fatal CAD, 25 had narrowing >75% of 1 or more major epicardial coronary arteries. Thus, 73 of the 231 (32%) patients at necropsy had severe CAD. Comparison between the fatal CV and fatal non-CV cases disclosed variable age (mean 64 years vs mean 57 years) and heart weight (529 g vs 449 g) to be significantly different. Heart weight was found to be the only significantly variable between men and women. Comparison of the heart weights in this study to those recorded as "normal" hearts 75 to 115 years earlier showed that today's "average" heart is much larger than those reported earlier. In contrast to the earlier studies, heart weight presently appears to increase with age and with an increase in body mass index. In conclusion, early studies in heart weight did not take into account today's longer survival and therefore a high prevalence of systemic hypertension, diabetes mellitus, obesity (and cardiac adiposity), and the presence of atherosclerotic CAD. Additionally, the cause of death (CV vs non-CV) was rarely considered in the early studies of heart weight.

Comparison of Characteristics of Patients Undergoing Heart Transplantation at the Same Hospital in Two Different Time Periods (1997-2012 and 2013-2015).

Heart transplantation (HT) increases at some centers each year and decreases at others. We examined characteristics of patients having HT at the same hospital in 2 different time periods (1997-2012 and 2013-2015) by 2 different surgical groups. We compared certain clinical and morphological finding in 291 patients having HT 1997 to 2012 to finding in 228 other patients having HT from 2013 to 2015. Several significant (p <0.05) differences were found: in the most recent time period (2013-2015) compared to the earlier time period (1997-2012), the mean ages of the men were older (57 years -vs- 55 years); diabetes mellitus was more frequent (37% -vs- 21%); systemic hypertension (by history) was more frequent (59% -vs- 32%); the mean body mass index was higher (29.2 kg/m(2) -vs- 26.5 kg/m(2)), and mean heart weight was lower in both men (509 g -vs- 549 g) and women (422 g -vs- 454 g). There were insignificant (p >0.05) differences in gender, frequency of massive cardiac adiposity, underlying cardiac condition, frequency of coronary heart disease, and frequency of previous insertion of a left ventricular assist device. In conclusion, certain characteristics of patients having HT at one Texas hospital changed in several respects in 2 time periods corresponding to changes in surgeons doing the HTs.

Frequency of Massive Cardiac Adiposity (Floating Heart) in the Native Hearts of Patients Having Heart Transplantation at a Single Texas Hospital (2013 to 2015) and Comparison of Various Clinical and Morphologic Variables in the Patients With Massive Versus Nonmassive Cardiac Adiposity.

Body weight continues to increase worldwide due primarily to the increase in body fat. This study analyzes the frequency of massive adiposity at hearts of patients who underwent heart transplantation (HT) determined by the ability of the heart to float in a container of 10% formaldehyde (because adipose tissue is lighter than myocardium) and compares certain characteristics of those patients with and without floating hearts. The hearts studied at HT during a 3-year period (2013 to 2015) at Baylor University Medical Center were carefully "cleaned" and weighed by the same individual and tested as to their ability to float in a container of formaldehyde, an indication of severe cardiac adiposity. Of the 220 hearts studied, 84 (38%) floated in a container of formaldehyde and 136 (62%) did not. Comparison of the 84 patients with floating hearts to the 136 with nonfloating hearts showed a significant difference in ages, but a nonsignificant difference in gender, body mass index, frequency of systemic hypertension, or diabetes mellitus. The odds of a heart being a floating one was increased in patients with a diagnosis of ischemic cardiomyopathy (unadjusted odds ratio 2.12, 95% CI 1.21 to 3.70). The frequency of massive cardiac adiposity in the native hearts of patients having HT (38%) is striking and appears to have increased in frequency in the recent decades.

Massive Diffuse Calcification of the Ascending Aorta and Minimal Focal Calcification of the Abdominal Aorta in Heterozygous Familial Hypercholesterolemia.

A 41-year-old woman, the mother of 3 offspring, with likely heterozygous familial hypercholesterolemia, had been asymptomatic until age 38 when angina pectoris and exertional dyspnea appeared leading to the discovery of severe multivessel coronary artery disease and a massively calcified ascending aorta. Coronary bypass grafting using the right and left internal mammary arteries did not alleviate the symptoms. Evidence of overt heart failure subsequently appeared and that led to heart transplantation at age 41. She died 22 days later. The occurrence of massive diffuse calcification of the ascending aorta and minimal focal calcification of the abdominal aorta is rare and in the patient described it appears to be the consequence of heterozygous familial hypercholesterolemia.

Frequency of Massive Cardiac Adiposity (Floating Heart) at Necropsy and Comparison of Clinical and Morphologic Variables With Cases With Nonmassive Cardiac Adiposity at a Single Texas Hospital, 2013 to 2014.

Body weight continues to increase worldwide primarily because of the increase in body fat. This study analyzes the frequency of massive adiposity at autopsy determined by the ability of the heart to float in a container of 10% formaldehyde (because adipose tissue is lighter than myocardium) and compares certain findings in the patients with floating to those with nonfloating hearts. The hearts studied at necropsy during a 2-year period (2013 to 2014) at Baylor University Medical Center were carefully "cleaned" and weighed by the same person and tested as to their ability to float in a container of formaldehyde, an indication of severe cardiac adiposity. Of the 146 hearts studied, 76 (52%) floated in a container of formaldehyde and 70 (48%) did not. Comparison of the 76 patients with floating hearts with the 70 with nonfloating hearts showed significant differences in ages (62 ± 13 vs 58 ± 14 years). No significant differences between the 2 groups were found in gender, body mass index, frequency of systemic hypertension or diabetes mellitus, either acute or healed myocardial infarction, or whether death was due to a coronary or a noncoronary condition. A weak correlation was found between body mass index and heart weight in both men and women and in both floating and nonfloating hearts. The massive quantity of cardiac adipose tissue (floating heart) appears to have increased enormously in recent decades in the United States.

Characteristics of Hearts at Necropsy in Patients Treated Chronically With Prednisone (The Corticosteroid Heart).

It is known that long-term corticosteroid therapy increases fatty deposits in several human tissues. To quantify the quantity of fatty deposits in the heart in patients on prednisone, we examined the heart at necropsy in 37 patients who had received long-term corticosteroid therapy (prednisone in 34) and compared certain findings in them to those in 194 (steroid-naïve) patients also studied at necropsy at Baylor University Medical Center, Dallas, in a 3-year period (2013, 2014, and 2015). Significant differences between the 2 groups were found in age, gender, and frequency of coronary artery disease but not in body mass index, frequency of massive cardiac adiposity, heart weight, or frequency of systemic hypertension or diabetes mellitus. Furthermore, no significant differences were observed in the patients taking ≤20 mg versus those taking >20 mg daily of prednisone. In conclusion, this study observed no significant differences in body mass index, frequency of cardiac adiposity (floating heart), heart weight, or frequencies of systemic hypertension or diabetes mellitus in the patients receiving or not receiving prednisone for a long term, but the prednisone-treated patients were younger, more often women, and had a lower frequency of severe narrowing of ≥1 major coronary arteries.