Author + information
- Heinrich Taegtmeyer, MD, DPhil∗ ( and )
- Truong Lam, BS
- ↵∗Internal Medicine/Cardiology, University of Texas Medical School at Houston, 6431 Fannin, MSB 1.246, Houston, Texas 77030.
We read with interest the report on “Fat Deposition in Dilated Cardiomyopathy Assessed by CMR” by Lu et al. (1), because it describes a phenomenon already observed by Rudolph Virchow in 1858. In his book on cellular pathology, he devotes 2 full chapters to fatty atrophy of the heart (2). In lecture 16, he describes the fatty degeneration of the muscular substance of the heart in its different stages. Here we quote the text verbatim:
You will observe that, even with the naked eye, certain changes can be recognized in the heart, namely a discoloration of its whole substance (which no longer presents the red hue of muscle, but wears a pale yellow tint), and besides peculiar spots on the papillary muscles. If you examine these more closely, you will perceive, in the direction of the primitive fasciculi, short, yellowish streaks which communicate so as almost to present a plexiform arrangement, and pervade the substance of the papillary muscles, whilst they offer a striking contrast to the reddish colour of proper muscular substance. This is the perfect form of genuine fatty metamorphosis of the real muscular substance of the heart, which differs most essentially from obesity of the heart, in which this organ becomes extremely fat and adipose tissue here and there so infiltrates its walls, that scarcely any muscle is to be perceived.
Unlike Virchow, the investigators of the present study have not been able to distinguish between intramyocellular and extramyocellular fat. The investigators also elected to omit the metabolic profiles of their patients. This might be of importance because we identified a subgroup of heart failure patients with severe metabolic dysregulation featuring intramyocardial triglyceride overload and gene expression that are associated with contractile dysfunction (3). In the end, after more than 150 years we are all still walking in Virchow’s footsteps.
- American College of Cardiology Foundation
- Lu M.,
- Zhao S.,
- Jiang S.,
- et al.
- Virchow R.
- Sharma S.,
- Adrogue J.V.,
- Golfman L.,
- et al.