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The histology of viable and hibernating myocardium in relation to imaging characteristics

Mark G. Gunning, MRCP^*, Raffi R. Kaprielian, MA, MRCP, John Pepper, MChir, FRCS, Dudley J. Pennell, MD, FRCP^*, Mary N. Sheppard, MD, FRCPath, Nicholas J. Severs, PhD, DSc, Kim M. Fox, MD, FRCP and S. Richard Underwood, MD, FRCP^*,*

^* Department of Cardiac Imaging, Royal Brompton Hospital and Imperial College School of Medicine, London, United Kingdom
Department of Cardiology, Royal Brompton Hospital and Imperial College School of Medicine, London, United Kingdom
Department of Histopathology, Royal Brompton Hospital and Imperial College School of Medicine, London, United Kingdom
Department of Cardiac Surgery, Royal Brompton Hospital and Imperial College School of Medicine, London, United Kingdom

View larger version (131K): [in a new window]   Figure 1 Thin-section electron micrograph illustrating typical features of a "pathological" myocyte, with large areas of cytoplasm (c) devoid of contractile proteins and full of glycogen, numerous small mitochondria (m) and an irregularly shaped nucleus (n). Certain sarcomeres are in a hypercontracted state (contraction bands [b]). Bar = 10 µm.

View larger version (102K): [in a new window]   Figure 2 Histologic sections stained with phosphotungstic acid/hematoxylin. (A) Image comparable to the electron micrograph in Figure 1 and demonstrating light microscopic appearance of loss of myocyte contractile apparatus (contractile proteins stain dark purple; most cells demonstrate cytoplasm devoid of protein [c]). (B) Nonrecovering (infarcted) segment again showing abnormal myocytes but with a high fibrous tissue content (f). (C) Hibernating tissue again showing a high proportion of myocytes depleted in contractile protein, but with relatively low volume fraction of fibrous tissue compared to B.

View larger version (43K): [in a new window]   Figure 3 Mean myocyte fraction in segments predicted to be hibernating by each of the imaging techniques, according to agreement with true hibernation assessed by postoperative function. The number of segments in each of the predictive categories is shown by n. For each imaging technique, true negative segments (true scar) had a significantly lower myocyte fraction when compared with true positive segments (p < 0.05).

View larger version (47K): [in a new window]   Figure 4 Mean myocyte fraction in segments predicted to be hibernating (+) or scar (–) by thallium single-photon emission tomography (Tl) and by magnetic resonance imaging (MRI). There were significantly more myocytes in segments predicted to be hibernating by both techniques than by thallium alone (p < 0.05).