Effect of Exercise Training on Nitric Oxide Synthasesin the Cardiovasculature and Kidney of Rats with Chronic Heart Failure

Abstract

Introduction: Cardiac involvement in systemic amyloidosis causes detrimental prognosis, therefore early detection and classification are important to develop appropriate therapeutic strategies. Subcutaneous tissue biopsy is a useful screening for systemic amyloidosis; however, its diagnostic and prognostic value in patients with cardiac amyloidosis remains elusive. Methods: We retrospectively analyzed 14 consecutive patients with cardiac amyloidosis who underwent subcutaneous tissue biopsy. Results: Amyloid deposition was observed in 11 patients (79%). Histopathological analysis demonstrated that acquired monoclonal immunoglobulin light-chain amyloidosis could be predicted when the degree of amyloid deposition was greater in blood vessels than adipose tissue compare to senile systemic amyloidosis and familial amyloidosis (60% vs. 0%; p50.03). During the follow-up period (median 297 days, range 3-761 days), 7 patients died or were admitted to the hospital due to worsening heart failure. Among them, 6 patients (86%) were positive for amyloid deposition in blood vessels. The incidence of death and composite outcome, including heart failure hospitalization and death, was significantly higher in patients positive for amyloid deposition in blood vessels than in those without (p50.03, p50.006; respectively). Conclusions: Amyloid subtype could be diagnosed by analyzing the degree of amyloid deposition in blood vessels and adipose tissue using subcutaneous tissue biopsy samples in patients with cardiac amyloidosis. Amyloid deposition in blood vessels suggests poor prognosis of these patients.