Morphometric investigation of human myocardium in arterial hypertension and valvular aortic stenosis

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Abstract
Both arterial hypertension and aortic stenosis lead to pressure overload of the left ventricle. As intramyocardial vasculature is confronted with pressure overload in hypertension but not in aortic stenosis, structural differences are to be expected in both forms of left ventricular hypertrophy. With the aid of morphometry, we investigated human myocardium from autopsied hearts from six patients with arterial hypertension and 10 controls, as well as myectomy specimens from cardiac surgery from 14 patients with aortic stenosis. Mean left ventricular myocytic diameter was significantly (P<0·05) increased compared with controls (12·4±1·5 µm) during hypertension (+27%) as well as aortic stenosis (+65%) (P<0·05). This was combined with a greater volume density of perimyocytic fibrosis (controls = 0·8±0·4 Vv%) during hypertension (+250%) and aortic stenosis (+587%) (P<0·05). Walls of intramyocardial arterioles (external diameter 20–40 and 40–80 µm) were thickened to 32% and 44% (P<0·05) during hypertension, but not during aortic stenosis. Compared with controls, perivascular fibrosis of these arterioles was increased by +215% and 61% (P<0·05), respectively, during hypertension, but not during aortic stenosis.

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