Immunosuppressive treatment for myocarditis and dilated cardiomyopathy

Maisch, Bernhard; Herzum, Matthias; Hufnagel, G.; Bethge, Christian; Schönian, U

doi:10.1093/eurheartj/16.suppl_o.153

Cited by 51 publications

(29 citation statements)

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“…These findings are similar those of the Children's Hospital of Pittsburgh, 8 previous adult and pediatric systematic reviews, 38,39 and randomized trials in adults. 40,41 Recent pediatric studies using various regimens of IVIG and immunosuppression have reported somewhat higher rates of LV recovery than we did.…”

Section: Limitations Of the Studysupporting

confidence: 86%

Ventricular Remodeling and Survival Are More Favorable for Myocarditis Than For Idiopathic Dilated Cardiomyopathy in Childhood

Foerster

Canter

Cinar

et al. 2010

Circ: Heart Failure

134

105

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Background-Myocarditis is a cause of a new-onset dilated cardiomyopathy phenotype in children, with small studies reporting high rates of recovery of left ventricular (LV) function. Methods and Results-The presenting characteristics and outcomes of children with myocarditis diagnosed clinically and with biopsy confirmation (nϭ119) or with probable myocarditis diagnosed clinically or by biopsy alone (nϭ253) were compared with children with idiopathic dilated cardiomyopathy (nϭ1123). Characteristics at presentation were assessed as possible predictors of outcomes. The distributions of time to death, transplantation, and echocardiographic normalization in the biopsy-confirmed myocarditis and probable myocarditis groups did not differ (PՆ0.5), but both groups differed significantly from the idiopathic dilated cardiomyopathy group (all PՅ0.003). In children with myocarditis, lower LV fractional shortening z-score at presentation predicted greater mortality (hazard ratio, 0.85; 95% confidence interval, 0.73 to 0.98; Pϭ0.03) and greater LV posterior wall thickness predicted transplantation (hazard ratio, 1.17; 95% confidence interval, 1.02 to 1.35; Pϭ0.03). In those with decreased LV fractional shortening at presentation, independent predictors of echocardiographic normalization were presentation with an LV end-diastolic dimension z-score Ͼ2 (hazard ratio, 0.36; 95% confidence interval, 0.22 to 0.58; PϽ0.001) and greater septal wall thickness (hazard ratio, 1.16; 95% confidence interval, 1.01 to 1.34; Pϭ0.04). Conclusions-Children with biopsy-confirmed or probable myocarditis had similar proportions of death, transplantation, and echocardiographic normalization 3 years after presentation and better outcomes than those of children with idiopathic dilated cardiomyopathy. In children with myocarditis who had impaired LV ejection at presentation, rates of echocardiographic normalization were greater in those without LV dilation and in those with greater septal wall thickness at presentation. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005391.(Circ Heart Fail. 2010;3:689-697.)

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Section: Limitations Of the Studysupporting

confidence: 86%

Ventricular Remodeling and Survival Are More Favorable for Myocarditis Than For Idiopathic Dilated Cardiomyopathy in Childhood

Foerster

Canter

Cinar

et al. 2010

Circ: Heart Failure

134

105

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“…[8][9][10][11]16,17,[26][27][28] Attempts to treat DCM and myocarditis using immunosuppressive and antiviral agents have been reported. [29][30][31][32][33] In the present study, examination of myocardial specimens obtained by PLV, showed mononuclear cell infiltration in all of the specimens. Quantitative and qualitative analyses using leukocyte surface markers revealed the presence of inflammatory cell infiltrates (active myocarditis) in some cases.…”

Section: Discussionsupporting

confidence: 62%

Myocardial Inflammatory Cell Infiltrates in Cases of Dilated Cardiomyopathy as a Determinant of Outcome Following Partial Left Ventriculectomy.

et al. 2001

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eart transplantation has been used to treat dilated cardiomyopathy (DCM) in patients in whom medical therapy or a left ventricular assist device has failed. However, there are a limited number of hearts available for transplantation, and many patients die while awaiting transplantation. Recently, partial left ventriculectomy (PLV; the Batista procedure) 1-6 has received attention as an alternative or bridging treatment for severe cardiomyopathies. In this operation, the surgeon partially resects the left ventricle in an attempt to decrease left ventricular wall tension by reducing chamber volume. Therefore it is necessary to establish the indications for this procedure and to determine the prognosis following this surgery.Immunologic abnormalities, viral infections, and genetic predisposition are possible factors involved in the development of myocardial injury in DCM. 7 The presence of inflammatory cell infiltrates [8][9][10][11] and viral genomes [12][13][14][15] 16,17 It is therefore quite important to determine the role of inflammatory cell infiltrates or active myocarditis in the development of DCM.The histopathologic features of myocardial injury and the severity of cardiomyopathy are considered to be factors determining the prognosis following PLV. We previously reported that severe inflammatory cell infiltration might serve as a predictor of poor outcome, 18,19 but we could not determine a significant correlation between any histopathologic findings and the early prognosis of patients with DCM following PLV, because the number of patients was too small.The purpose of present study was to determine the involvement of active myocarditis in DCM using histopathologic, immunohistochemical and virologic studies of myocardial specimens obtained by PLV. In addition, this study aimed to determine the relationship between the histopathologic findings and the early prognosis of patients with DCM following PLV using more histopathologic factors in a larger number of cases compared with our previous study. 18,19 Jpn Circ J 2001; 65: 797 -802 (Received October 27, 2000; revised manuscript received May 28, 2001; accepted June 11, 2001 Yasuhiro Horii, MD*; Tadashi Isomura, MD*; Hisayoshi Suma, MD* Partial left ventriculectomy (PLV) can be used to treat refractory congestive heart failure caused by dilated cardiomyopathy (DCM). In order to understand the relationship between the underlying myocardial injury and early clinical outcomes after PLV, histopathologic, immunohistochemical and virologic studies of the resected myocardium were performed. The posterolateral left ventricular walls from 27 patients with idiopathic DCM were examined. Cardiomyocyte diameter, degree of myocardial fibrosis, degree of cardiomyocyte degeneration, and degree of inflammatory cell infiltration were compared with mortality rates. Polymerase chain reaction was performed to detect enterovirus genome in the myocardium. Some patients had inflammatory cell infiltrates with focal accumulations of lymphocytes and macrophages, including both cytot...

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“…20 The use of high-dose IVGG for treatment of acute myocarditis is of particular interest to several authors because it has few side effects and has positive results, such as improved recovery of left ventricular function, and with a tendency for better survival during the first year after presentation. [21][22][23] The major finding in KD is multisystem vasculitis, with a predilection for the coronary arteries, and pancarditis with inflammation of the conduction system, which sometimes appears to cause fatal arrhythmia or intractable congestive heart failure within 2 weeks after fever onset. 24 We considered that measuring cTnI in the acute stage of KD before and after treatment of IVGG was a useful method for the early detection of the myocardial cell injury in KD and for confirming the effectiveness of high-dose IVGG treatment.…”

Section: Discussionmentioning

confidence: 99%

Changes in Cardiac Troponin I in Kawasaki Disease Before and After Treatment With Intravenous Gammaglobulin

Kim¹,

Kim

1998

Jpn Circ J

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Changes in cardiac troponin I (cTnI) in Kawasaki disease before and after treatment with intravenous gammaglobulins (IVGG) were investigated in 42 cases in order to confirm the usefulness of cTnI as a serological test for the early onset of acute myocarditis and the effectiveness of IVGG as treatment for it. The level of cTnI before IVGG treatment was increased in 42.9% (18/42), but 89% (16/18) were in the normal range after treatment as shown by improved clinical symptoms and signs; 9.5% (4/42) were treated twice with IVGG because of recurrent high fever, with a positive level of cTnI in the second test. Despite the improved clinical symptoms and signs after retreatment with IVGG, 4.7% (2/42) continued to have an increased level of cTnI in follow-up studies. In conclusion, the measurement of cTnI is a useful serologic test for the early diagnosis of myocarditis or myocardial cell injury and for confirming the effectiveness of IVGG therapy for the cure and prevention of cardiovascular abnormalities in KD patients. (Jpn Circ J 1998; 62: 479 -482)

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Immunosuppressive treatment for myocarditis and dilated cardiomyopathy

Cited by 51 publications

References 0 publications

Ventricular Remodeling and Survival Are More Favorable for Myocarditis Than For Idiopathic Dilated Cardiomyopathy in Childhood

Ventricular Remodeling and Survival Are More Favorable for Myocarditis Than For Idiopathic Dilated Cardiomyopathy in Childhood

Myocardial Inflammatory Cell Infiltrates in Cases of Dilated Cardiomyopathy as a Determinant of Outcome Following Partial Left Ventriculectomy.

Changes in Cardiac Troponin I in Kawasaki Disease Before and After Treatment With Intravenous Gammaglobulin

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