The Predictive Utility of Lipofuscin and Fibrosis on Endomyocardial Biopsy in Adolescents and Young Adults.
Susan J Parson, Stuart D Russell, Mosi K Bennett, Justin M Dunn, Nisha Aggarwal, Shaline Rao, Colleen Harrington, Tasha Beck, Marc K Halushka. Saba University SOM, The Bottom, Saba, Netherlands Antilles; Johns Hopkins University SOM, Baltimore, MD
Background: The amount of interstitial fibrosis and lipofuscin present in endomyocardial biopsy samples are thought to indicate the chronicity of heart failure. Fibrosis is known to increase in the failing heart. Lipofuscin is known to increase with age, but its relationship to heart function is unknown. This study was undertaken to determine if lipofuscin or fibrosis had predictive utility in indicating recovery of function or adverse event (death, transplant, assist device placement) at one year post-biopsy in adolescents and young adults.
Design: A retrospective analysis was performed for all non-transplant endomyocardial biopsies performed at our institution from 2000-2009 on individuals aged 10-40. Clinical and demographic information including ejection fraction (EF), EF at one year, cardiac index, death, transplantation, assist device use, sex and ethnicity were obtained as available. The degree of fibrosis was taken from the surgical pathology record. The amount of lipofuscin was scored retrospectively in a blinded fashion on all biopsies. Linear regression and Cox proportional hazard models were used for multivariable analysis.
Results: In all, 201 biopsies were included in the study. As expected, increasing lipofuscin strongly correlated with patient age (p<0.0001). Surprisingly, higher levels of lipofuscin were correlated with higher EF scores at one year (p=0.02). This remained significant (p=0.01) after adjusting for age. More fibrosis was associated with lower EF at one year (p=0.04), although it became nonsignificant after age adjustment. Increased fibrosis, but not lipofuscin, predicted having an adverse event by one year (p=0.02).
Conclusions: The endomyocardial biopsy can be used to diagnose disease at the time of biopsy. This is the first study to incorporate lipofuscin as a histologic finding to predict heart function at one year. Our study demonstrates that in an adolescent and young adult population, both lipofuscin and fibrosis can prognosticate how well a patient's heart will be functioning in one year. This information can be used to help clinicians devise treatment plans for individuals in this age group.
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 30, Wednesday Afternoon