Contraction-band necrosis: patterns of distribution in the myocardium and their diagnostic usefulness in sudden cardiac death

Abstract

Experimentally-produced acute regional myocardial infarcts of 2 or more hours duration show a characteristic pattern of myocardial cell alteration known as "contraction-band necrosis". To investigate the potential usefulness of this feature in assessing the myocardial status in sudden cardiac death, detailed histological examinations of the coronary arteries and midventricular myocardium were carried out on hearts from 70 unselected cases of sudden cardiac death. Contraction-band necrosis was frequently encountered and occurred in 3 main patterns which could be correlated with the coronary artery pathology and the case history: a regional distribution consistent with early subendocardial or transmural infarction, not yet characterized by coagulative necrosis, associated in most cases with a recent thrombotic event in the relevant supply artery (27.1%); adjacent to pre-existing infarction (recent or healed) or to subendocardial fibrosis resulting from severe coronary artery disease, consistent with recent extension of ischemic injury (18.6%); a global, full-transmural distribution, consistent with reperfusion injury from delayed resuscitation in the absence of significant coronary artery pathology (8.6%). Thus, examination of the myocardium for a specific pattern of contraction-band necrosis may frequently facilitate the definitive diagnosis of sudden cardiac death.