GRAFT ARTERIOSCLEROSIS-INDUCED MYOCARDIAL PATHOLOGY IN HEART-TRANSPLANT RECIPIENTS - PREDICTIVE VALUE OF ENDOMYOCARDIAL BIOPSY

Background: Ischemic myocardial pathology resulting from graft arterio sclerosis (GA) includes subendocardial myocyte vacuolization (SEMV), i ndicative of sublethal ischemic injury, and coagulative myocyte necros is, acute and healing (CMN), indicative of infarction. Methods: To ass ess the sensitivity and specificity of myocardial pathology resulting from GA in endomyocardial biopsy specimens, we correlated SEMV and CMN in the final three biopsy specimens (mean interval from last biopsy t o death 23 +/- 20 days) with autopsy findings from 30 heart transplant recipients who survived more than 3 months and died of GA (n = 16) or of other causes (n = 14). The two groups were similar in other parame ters. Results: Myocardial ischemic injury was present at autopsy in al l 16 patients with GA with the following distribution: SEMV (n = 13) n ine right ventricle (RV) and left ventricle (LV), four LV only; focal CMN (n = 8) six RV and LV, two LV only; subendocardial infarct (n = 3) three LV only; and transmural infarct (n = 3) one RV, two LV. Ischemi c injury was present in the RV of 11 of 16 patients with GA. Of patien ts without GA, one had SEMV gt autopsy; none had infarcts. Ischemic my ocardial pathology was present in 10 of 48 biopsy specimens from patie nts with GA compared with one of 41 biopsy specimens from patients wit hout GA (p < 0.05). The specificity of SEMV on biopsy was 98%, but sen sitivity was only 17%. The positive predictive value for ischemic inju ry was 92%, and negative predictive value was 51%. Conclusions: Myocar dial pathology resulting from ischemia was present at autopsy in all p atients dying of GA. Although more prevalent in the LV, 69% of patient s had ischemic myocardial pathology in the RV, where it may be accessi ble to biopsy. Ischemic myocardial pathology in biopsy specimens is hi ghly specific but far less sensitive, for diagnosing GA.