Early Lesion Of Coronary Atherosclerosis In End-stage Idiopathic Dilated Cardiomyopathy

Objective:1.Pathological study of coronary artery specimens of patients with end-stage idiopathic dilated cardiomyopathy was conducted to explore the pathological features of slight coronary artery lesions in patients with idiopathic dilated cardiomyopathy;2.To explore the biological characteristics of smooth muscle cells in mild coronary artery lesions and their role in the development of these lesions.Methods:This study has obtained in guangdong province people's hospital ethics committee approval,Coronary arterial trees were obtained from the failing hearts of 36 patients aged from 6 to 61 years old after their heart transplantation from November 1,2017 to November 30,2018 in our hospital with end-stage cardiomyopathy.The fixed tissue sections were stained with hematokin-eosin(H&E),masson-trichrome and VERHOEFF's van-gieson(EVG)respectively to determine the thickness of intima and media,calculate the ratio of intima to media thickness,and determine the collagen volume fraction to quantitatively evaluate the lesion severity.The paraffin sections were subjected to immunohistochemical staining with anti-cd163 antibody,anti-caldesmon antibody,anti-desmin antibody,anti-smoothelin antibody,anti-ki-67 antibody,anti-bax antibody and anti-tem1 antibody respectively,and semi-quantitative detection was conducted.Results:All 36 patients had different degrees of atherosclerotic lesions in the coronary arteries,among which 9 patients met the diagnostic criteria of diffuse intimal thickening,and the remaining 27 patients had pathological intimal thickening,plaque formation and other more severe atherosclerotic lesions.Histological staining of 9 patients indicated that the same section had different degrees of lesions,and the internal elastic layer showed different degrees of degeneration from integrity to complete destruction.Where the inner elastic layer is completely normal or slightly damaged,the inner membrane is slightly thickened and less than the middle membrane,and the structural contour of the inner elastic layer is still relatively intact.The inner elastic layer degenerates obviously,and the inner elastic layer shows the phenomena of lamination,fragmentation and repetition.The abnormal cell morphology in the inner layer of the middle membrane,that is,the part near the inner elastic layer,is filled by a large number of spindle-shaped smooth muscle cells.With the aggravation of the degradation of the inner elastic layer,the density of endometrial Bax positive cells decreased and the density of TEM1 positive cells increased,suggesting the decrease of endometrial smooth muscle cell apoptosis and phenotypic transformation.Conclusion:Coronary atherosclerosis is ubiquitous in patients with end-stage IDCM.IEL spliting and smooth muscle cells phenotype switching and apoptosis reducing could happen as promotion factors for DIT progress of coronary artery.