Mitochondrial ultrastructure in cardiac myocytes is associated with the cardiovascular death in patients with heart failure

doi:10.4330/wjc.124556

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World Journal of Cardiology

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1949-8462

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Cardiol. Aug 26, 2026; 18(8): 124556
Published online Aug 26, 2026. doi: 10.4330/wjc.124556

Mitochondrial ultrastructure in cardiac myocytes is associated with the cardiovascular death in patients with heart failure

Elena A Kuzheleva, Alla A Garganeeva, Olga V Tukish, Ekaterina E Syromyatnikova

Elena A Kuzheleva, Alla A Garganeeva, Olga V Tukish, Ekaterina E Syromyatnikova, Department of Myocardial Pathology, Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634012, Russia

Author contributions: Kuzheleva EA contributed to the research concept, participated in all stages of data collection, statistical analysis, image processing, and drafted the manuscript; Garganeeva AA developed the research concept and design, supervised the study, critically revised the manuscript for important intellectual content, and gave final approval of the version to be published; Tukish OV was involved in patient recruitment, data collection, and statistical analysis; Syromyatnikova EE performed patient recruitment and microphotograph processing; and all authors have read and approved the final manuscript.

AI contribution statement: We have not used any AI tools or technologies to prepare this manuscript.

Supported by the Russian Science Foundation, No. 23-75-00009.

Institutional review board statement: This study was approved by the Medical Ethics Committee of the Cardiology Research Institute, Tomsk National Research Medical Center of the Russian Academy of Sciences (Russia), approval No. 241.

Clinical trial registration statement: The protocol of this single-center prospective study was officially registered at ClinicalTrials.gov (Registration Identifier: NCT05770349).

Informed consent statement: Informed consent was obtained from all individual participants included in the study prior to their recruitment.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.

Data sharing statement: Depersonalized dataset and microphotographs available from the corresponding author at kea@cardio-tomsk.ru.

Corresponding author: Elena A Kuzheleva, Senior Researcher, Department of Myocardial Pathology, Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Kievskaya str, 111a, Tomsk 634012, Russia. kea@cardio-tomsk.ru

Received: June 22, 2026
Revised: July 28, 2026
Accepted: August 14, 2026
Published online: August 26, 2026
Processing time: 69 Days and 14.4 Hours

Abstract

BACKGROUND

Mitochondria are considered a promising target for the treatment of cardiovascular disease. However, there has not been a direct association confirmed between mitochondrial ultrastructure in cardiac myocytes and cardiovascular death (CVD) in patients with heart failure (HF).

AIM

To evaluate the association between mitochondrial ultrastructure in cardiac myocytes and CVD in patients with HF who underwent coronary artery bypass grafting (CABG).

METHODS

It was a prospective study of HF patients that used electron microscopy of human cardiac myocytes. A total of 40 patients with HF (left ventricular ejection fraction < 50%) with coronary artery disease who underwent CABG were included (ClinicalTrials.gov: NCT05770349). Right atrial appendage biopsies were obtained during CABG. Ultrastructural analysis of mitochondria was performed using a JEM-1400 transmission electron microscope. The “Total area of interfibrillar mitochondria” and the “Ratio of mitochondrial membrane lengths” were calculated. Patients were followed for 12 months: 6 CVDs were recorded (15%). Statistical analysis was performed using IBM SPSS Statistics version 21; statistical significance was defined as P < 0.05.

RESULTS

From 3 to 5 Longitudinal sections were examined at 5000 × magnification and at 15000 × magnification for each patient (a total of over 250 micrographs were analyzed). The median of the total area of interfibrillar mitochondria was 41% (34; 63); the median of the ratio of the outer membrane length to the inner mitochondrial membrane length was 30% (22; 36). Univariate analysis demonstrated statistically significant differences between the ratio of mitochondrial membrane lengths in patients with and without CVD [29% (20, 33.5) vs 41% (35, 45), P = 0.001]. Patients with CVDs were also more often hospitalized due to HF before CABG and had a long duration of hospitalization after CABG.

CONCLUSION

A disruption in the mitochondrial ultrastructure in cardiomyocytes in the right atrial auricle might be associated with the development of CVD in patients with HF who underwent CABG.

Keywords: Heart failure; Electron microscopy; Mitochondrial ultrastructure; Coronary artery bypass grafting; Cardiovascular death

Core Tip: A prospective observational study using electron microscopy of right atrial appendage cardiomyocytes in patients with heart failure and coronary artery disease who underwent coronary artery bypass grafting was conducted. It was shown that the internal ultrastructure of cardiomyocyte mitochondria, calculated as the ratio of the lengths of the outer and inner membranes, may be associated with the development of fatal outcome during a 12-month prospective follow-up.