Electron microscopic observations of apoptotic cells in various etiologies of human cardiovascular diseases

Objective To observe apoptotic process in various cardiovascular disorders with a particular attention to the ultrastructural morphology of apoptosis in cardiomyocytes, fibroblasts, vascular endothelial cells and smooth muscle cells. Methods Transmission electron microscopic observations of the tissue specimens obtained from endomyocardial biopsies or surgical excisions of left ventricular myocardium or calcified aortic valves were carried out in 50 patients with various cardiovascular diseases. Results The ultrastructural features of apoptosis was consistently observed in cardiomyocytes, fibroblasts, vascular endothelial cells and smooth muscle cells in all diseased tissues. In cardiomyopathies and rheumatic heart diseases apoptosis was commonly observed in the cardiomyocytes. It was often found that fibroblasts underwent apoptosis in calcific aortic valve tissues. Apoptosis of arterial smooth muscle cells was a frequent finding in renal arterial stenosis due to Takayasu's arteritis and fibromuscular dysplasia. Regardless of the cell types, the nuclear hallmarks of apoptosis were identical with minor modifications of the fragmentation of the condensed cells into apoptotic bodies. Conclusions Based on electron microscopic findings, it is suggested that the underlying disease processes determine which type of cells predominantly undergoes apoptotic changes in various cardiovascular disorders. In addition, different cells with similar structural morphology may have common ultrastructural features of apoptosis.