Myocytes' apoptosis and proliferation in endomyocardial biopsy as prognostic factors in terminal heart failure

The aim of the preliminary study was to evaluate the role of apoptosis and proliferation of myocytes in order to predict the prognosis and optimal tre atment of patients with end-stage dilated cardiomyopathy. Endomyocardial bi opsy was performed during open-heart surgery (reductive annuloplasty of dou ble orifice) in 19 patients with end-stage dilated cardiomyopathy. The term inal deoxynucleotidyl transferase d-UTP-biotin nick-end labelling (TUNEL) m ethod was used for the detection of apoptosis, and immunohistochemical meth ods were used for the evaluation of inhibitor of apoptosis such as proto-on cogene Bcl-2 (B-cell lymphoma gene), and proliferative markers such as prol iferation cell nuclear antigen (PCNA) and Ki-67 proliferative antigen. The increased percentage of apoptotic myocytes and decreased expression of bcl- 2 is associated with earlier death after surgery. Increased expression of p roliferation markers of myocytes in patients who survived seven years after surgery compared to those who died within three years suggest that adult c ardiomyocytes are not terminally differentiated and this might represent po tential growth reserve of the diseased heart. Based on our preliminary stud y we may conclude that myocytes' apoptosis and proliferative activity might help us to predict the prognosis and optimal treatment of patients with en d-stage dilated cardiomyopathy.