Diagnosis and presentation of fatal myocarditis

Kytö, Ville; Saukko, Pekka; Lignitz, Eberhard; Schwesinger, G; Henn, V.; Saraste, Antti; Voipio‐Pulkki, Liisa‐Maria

doi:10.1016/j.humpath.2005.07.009

Cited by 48 publications

(37 citation statements)

References 27 publications

(26 reference statements)

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“…Giant cell myocarditis is known as a rare fatal disease [40]. It had been reported in 4% of cases in a study done in Sweden [35] and 17% of cases in a study done in Finland [36]. Thus our study further confirmed the existing data on cellular variants and their frequency in myocarditis.…”

Section: Discussionsupporting

confidence: 89%

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Sudden death related myocarditis: a study of 56 cases

Kitulwatte

Kim

Pollanen

2009

Forensic Sci Med Pathol

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Fifty-six cases of sudden death from myocarditis were reviewed to characterize the range of histologic appearances of myocarditis. All autopsy cases of myocarditis over 13 years (1996-2008) in the Toronto Forensic Pathology Unit, Ontario Forensic Pathology Service, were studied. In each case, historical documentation and histological slides were reviewed. The severity of myocarditis was graded qualitatively and quantitatively (the inflammatory index). We established the inflammatory index in order to classify the severity of myocarditis, by counting the mean number of inflammatory foci per section of myocardium. Based on the inflammatory index, myocardial inflammation was classified into four grades. Based on this classification, 47% of the cases were classified as marked myocarditis having an inflammatory index over 5, with the number of foci per slide varying from 3 to more than 10, while 20% were classified as mild myocarditis with an inflammatory index between 1.1 and 1.9 with the number of foci per slide varying from 0 to 6. The diagnosis of mild myocarditis is dependent on adequate sampling. We believe that the use of this inflammatory index enhances the post-mortem diagnostic sensitivity of myocarditis, especially in its mild form and correlates with qualitative assessment of the histologic severity of myocarditis.

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Section: Discussionsupporting

confidence: 89%

“…It is known that the commonest type of inflammatory infiltrate in myocarditis is lymphocytes [4,35]. In a Finnish study of 46 cases of myocarditis, 34 (74%) were lymphocytic myocarditis [36]. We found the same percentage of lymphocytic myocarditis in our study (predominant cellular infiltrate in 41 cases (74%) was lymphocytes).…”

Section: Discussionsupporting

confidence: 80%

Sudden death related myocarditis: a study of 56 cases

Kitulwatte

Kim

Pollanen

2009

Forensic Sci Med Pathol

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“…It is therefore possible that GCM was underdiagnosed in the 1990s and over the first years after 2000. Kytö et al 8 reported recently that GCM caused 5.6% of the 649 fatalities attributed to myocarditis in death certificates between 1970 and 1988 in Finland. Resulting in an estimate of 35 fatal cases over 18 years in an era of missing premortem recognition of GCM, these data support the representativeness of the present series.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis, Treatment, and Outcome of Giant-Cell Myocarditis in the Era of Combined Immunosuppression

Kandolin

Lehtonen

Salmenkivi

et al. 2013

Circ: Heart Failure

221

257

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G iant-cell myocarditis (GCM) is known as a rare, rapidly progressive, and frequently fatal myocardial disease in young and middle-aged adults. It is attributed to a T lymphocyte-mediated inflammation of the heart muscle and associates with systemic autoimmune diseases in ≈20% of cases. 1,2The most common early manifestations are heart failure, ventricular arrhythmias, and atrioventricular block, but GCM may also disguise as an acute myocardial infarction and rarely presents as an unexpected sudden cardiac death.1-3 The diagnosis of GCM rests fully on microscopy of the heart muscle and even in experienced centers >4 in 10 cases may escape detection until autopsy or cardiac transplantation. Aside from nonspecific measures to combat its symptomatic manifestations, the treatment of GCM relies on immunosuppression. Retrospective observations from the Multicenter GCM Registry 1,4 and a small prospective study with repeat biopsies 5 suggest that cyclosporine-based combined immunosuppression may be able to reduce myocardial inflammation 5 and improve clinical outcome. 1,4,5 Yet, these data are uncontrolled and suffer from lack of details about the treatments given 1,4 and the possibility of survivor bias. 1,4,5 The key problem is that the rarity and seriousness of GCM make controlled treatment trials, let alone use of a placebo arm, virtually impossible. The only such attempt, a cooperative endeavor by 17 centers, was terminated after 6 years because of difficulties in recruiting patients.5 Therefore, carefully studied observational patient series continue to add to the knowledge about GCM. We report here our experience in 32 patients with GCM, of whom 26 received combined immunosuppression. We focus on the diagnosis of GCM and on the outcome of patients with contemporary treatment. Our key observations suggest that repeat and imaging-guided biopsies increase the detection rate of GCM and that combined immunosuppression supported by therapy for heart failure and arrhythmias may result in transplant-free survival in two thirds of patients. Clinical Perspective on p 22 Methods PatientsFrom the year 1991 through 2011, 32 patients with histologically verified GCM were seen at the Division of Cardiology, Helsinki University Central Hospital. The majority of diagnoses (29/32) were made after year 2000, that is, during the latter half of the study period. The medical records, laboratory test, imaging studies, and available biopsy material of all patients were retrospectively reviewed and © 2012 American Heart Association, Inc. Background-Giant-cell myocarditis often escapes diagnosis until autopsy or transplantation and has defied proper treatment trials for its rarity and deadly behavior. Current therapy rests on multiple-drug immunosuppression but its prognostic influence remains poorly known. We set out to analyze (1) our experience in diagnosing giant-cell myocarditis and (2) the outcome of patients on combined immunosuppression. Methods and Results-We reviewed the histories, diagnostic procedures, details of treatment, a...

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“…In forensic medicine these techniques have been applied for the diagnosis of e.g. myocarditis [2,24,[44][45][46].…”

Section: Diagnosis Of Infectionmentioning

confidence: 99%