Abstract
The term "Fractal" is derived from the Latin fractus meaning "irregular" or "broken" considering the observed structure with a non-integer dimension. There are many studies which employed the Fractal Dimension (FD) as a diagnostic tool. One of the most common methods for its study is the "Box Counting Method". The aim of the present study was to try to establish the contribution of FD in the quantification of myocardial cellular rejection after cardiac transplantation. Microscopic digital images were captured at 800x600 resolution (magnification 100x). FD was calculated with the aid of "ImageJ software" with adaptations. The classification of the degrees of rejection was in agreement with the "International Society for Heart and Lung Transplantation" (ISHLT 2004). The final report of the degree of rejection was confirmed and redefined after an exhaustive review of the slides by an external experienced pathologist. 658 slides were evaluated with the following distribution among the degrees of rejection (R): 335 (0R); 214 (1R); 70 (2R); 39 (3R). The data were statistically analyzed with Kruskal-Wallis tests and ROC curves being considered significant values of P < 0.05. There was significant statistical difference between the various degrees of rejection with the exception of R3 versus R2. The same trend was observed in applying the ROC curve. FD may contribute to the assessment of myocardial cellular rejection. Higher values are directly associated with progressively higher degrees of rejection. This may help in decision making of doubtful cases and those which contemplate the intensification of immunosuppressive medication.
Highlights
The term “Fractal” is derived from the Latin fractus meaning “irregular” or “broken” considering the observed structure with a non-integer dimension
There is a tendency that the higher levels of cardiac rejection are related to higher values of fractal dimension
In differentiating between grades 3 versus 2, the area under the curve was 0.5289 and there is separation of groups 3 and 2 in terms of Fractal Dimension
Summary
The term “Fractal” is derived from the Latin fractus meaning “irregular” or “broken” considering the observed structure with a non-integer dimension. The current surgical methods for heart implants are primarily designed to allow the extension of life, and the technical, surgical, scientific, social and ethical difficulties have been largely overcome, it should be emphasized the problem of rejection, which is an important factor which can limit the lifetime of the graft and, the long-term success [1,2]. It occurs as a causal factor to the presence of preformed cytotoxic antibodies in the recipient against antigens of the donor. It is characterized by sudden and irreversible dysfunction of the graft from minutes to hours after revascularization, with thrombotic occlusion of the microvasculature, the following neutrophil infiltration and hemorrhage in the myocardium [3]. During the first year after transplantation, the incidence of acute rejection is situated around 40 episodes of rejection per 100 patients per month [4]
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