The morphologic spectrum of dilated cardiomyopathy and its relation to immune-response genes

Eloisa Arbustini, Antonello Gavazzi, Roberto Pozzi, Maurizia Grasso, Angela Pucci, Carlo Campana, Gabriella Graziano, Miryam Martinetti, Mariaclara Cuccia, Laura Salvaneschi, Luigi Martinelli, Carlo Montemartini, Mario Vigano

Research output: Contribution to journalArticlepeer-review


Endomyocardial biopsies from 174 patients with dilated cardiomyopathy (DC) were examined. Eight patients with histotogically proven myocarditis were excluded from the study. A peculiar pattern of oversized and bizarre nuclei was observed in only some of the remaining patients. Two groups were identified: those with and without this feature (groups A and B, respectively). Myocyte width, nuclear diameter and nuclear/sarcoplasmic ratio were significantly higher in group A. The mean respective values were 36 ± 5 μ, 14 +- 3 μ and 0.41 ± 0.08 for group A versus 20 ± 8 μ, 7 ± 2 μ and 0.37 ± 0.08 for group B. Interstitial fibrosis was similarly present in groups A and B. Endocardial thickness was significantly increased in all patients, with group A showing the highest mean value. The morphologic features showed no correlation with the clinical condition of the patients at time of presentation. HLA typing was performed in 50 consecutive patients, 38 from group A and 12 from group B. DR4 and DR5 antigens were significantly more frequent in DC patients than in a normal population control (400 blood donors), while DR3 was less frequent. Group A was more strongly associated with the DRS antigen than group B (55.3 vs 25.0%, respectively). It was less strongly associated with the DR4 antigen compared with group B (21.5 vs 41.7%, respectively). No difference was observed between the 2 groups concerning negative association with the DR3 antigen. Endomyocardial biopsies from DC patients reveal marked morphologic changes from patient to patient. The histopathologic identification of 2 distinct DC groups with different HLA marker associations suggests that immune-response genetic factors may play a role in the histopathologic expression of the disease.

Original languageEnglish
Pages (from-to)991-995
Number of pages5
JournalThe American Journal of Cardiology
Issue number16
Publication statusPublished - Nov 1 1989

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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