Isolated Myocarditis

Whitehead, R.

doi:10.1136/hrt.27.2.220

Cited by 54 publications

(18 citation statements)

References 34 publications

(11 reference statements)

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“…Tesluk [79] first distinguished the well organized, granulomatous lesions of cardiac sarcoidosis from a diffuse, non-granulomatous infiltrate, which he called "giant cell myocarditis". Most authorities since have considered giant cell myocarditis a distinct clinical and pathological entity rather than a virulent form of isolated cardiac sarcoidosis [17,55,84].…”

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confidence: 99%

“…In a Japanese autopsy registry, the incidence of giant cell myocarditis was 0.007% (25 of 377,841 cases from 1958 to 1977) [63]. The incidence of giant cell myocarditis was a similarly low 3 of 12,815 necropsies from 1950 to 1963 at Oxford Infirmary [84]. In the early 1990s a selection of large, United States heart failure referral centers encountered a case of giant cell myocarditis (diagnosed by biopsy, apical wedge section, explanted heart or autopsy) about every 21 months (Giant Cell Myocarditis Registry, unpublished data).…”

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Giant Cell Myocarditis: Diagnosis and Treatment

Cooper

2000

Herz

109

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Giant cell myocarditis is a rare but devastating disease that usually affects young otherwise healthy individuals. Associations with thymoma, inflammatory bowel disease, and a variety of autoimmune disorders have been reported. The rate of death or heart transplantation is approximately 70% at 1 year. Data from a Lewis rat model and from observational human studies suggest that giant cell myocarditis is mediated by T lymphocytes and may respond to treatment aimed at attenuating T cell function. Recent findings from the Giant Cell Myocarditis Registry, a clinical and pathologic database from 63 cases of giant cell myocarditis gathered from 36 medical centers, include the following: The sensitivity of endomyocardial biopsy for giant cell myocarditis for patients who undergo transplantation or autopsy is 82 to 85%. Registry subjects who received cyclosporine in combination with steroid, azathioprine, or muromonab-CD3 have prolonged transplant-free survival (12.6 months vs. 3.0 months for no immunosuppression). Post-transplantation survival is approximately 71% at 5 years despite a 25% rate of giant cell infiltration in the donor heart. To confirm and extend these findings, a randomized trial of immunosuppression including muromonab-CD3, cyclosporine, and steroids is underway.

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Giant Cell Myocarditis: Diagnosis and Treatment

Cooper

2000

Herz

109

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“…In larger autopsy series, the incidence of GCM has been reported to range from 0.007% to 0.051%. [1][2][3] Given that autopsies are not routinely performed on an unselected population, and patients dying of GCM may not undergo autopsy, it is likely these figures underestimate the true incidence. In the United States in the 1990s, a group of major heart failure referral centers reportedly diagnosed GCM (via autopsy, endomyocardial biopsy, apical wedge resection, or cardiac explantation) an average of once every 21 months.…”

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Giant Cell Myocarditis: A Brief Review

Brooks²

2016

Archives of Pathology &Amp; Laboratory Medicine

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Giant cell myocarditis (GCM) is a rapidly progressive and frequently fatal disease that mainly affects young to middle-aged previously healthy individuals. Early diagnosis is critical, as recent studies have shown that rapidly instituted cyclosporine-based immunosuppression can reduce inflammation and improve transplant-free survival. Before the 1980s, GCM was mainly a diagnosis made at autopsy. Owing to advancements in diagnostic and therapeutic options, it is now increasingly diagnosed on the basis of endomyocardial biopsies, explanted hearts, or apical wedge sections removed at the time of ventricular assist device placement. Histologic examination remains the gold standard for diagnosis; however, there are many possible etiologies for cardiac giant cells. Having a working knowledge of the clinicopathologic features that distinguish GCM from other giant cell–containing lesions is essential, since such lesions can have widely divergent management and outcome.

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“…7,8 Initially included under the more general term granulomatous myocarditis, in 1956 Tesluk first distinguished it from sarcoidosis. 9 Since then, a little more than a 100 cases have been reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

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Berthelot-Richer

O’Connor²,

Bernier³

et al. 2014

Exp Clin Transplant

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Objectives: Giant cell myocarditis is a rare and often fatal disorder. According to the American Heart Association, the American College of Cardiology Foundation, and the European Society of Cardiology scientific statements, an endomyocardial biopsy should be done to exclude giant cell myocarditis in unexplained new-onset heart failure of 2 weeks to 3 months duration associated with dilated left ventricle and new ventricular arrhythmias, or Mobitz type II second-degree, or third-degree atrioventricular heart block. Case Presentations: Two hundred thirty-five heart transplants were performed since May 1993 at the Institut universitaire de cardiologie et de pneumologie de Quebec, Canada. Giant cell myocarditis was found in the explanted hearts of 5 patients. The preoperative diagnosis of giant cell myocarditis was done by endomyocardial biopsy or at the installation of a left ventricular-assisted device. Patients had symptoms of progressive heart failure of subacute onset. Patients consulted at a mean 32 days after the onset of symptoms. Two patients neither had ventricular arrhythmia nor heart block. Two patients had ventricular arrhythmias and heart block; the other patient had symptomatic heart block. All patients had at least 2 echocardiographies. Two patients had an increase in left ventricular size, enough to reach the criteria of left ventricular dilatation according to the American Society of Echocardiography. During this time, left ventricular ejection fraction showed a rapid decline (mean 37% to 16%). Conclusions: Ventricular arrhythmia, heart block, and left ventricular dilatation initially can be absent in many patients having giant cell myocarditis with symptoms of progressive heart failure. Endomyocardial biopsy should be quickly considered in patients with a rapid and dramatic decline of left ventricular ejection fraction, even in the absence of classic clinical and echocardiographic features of giant cell myocarditis to rapidly obtain the diagnosis of this rare but lethal disease.

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Isolated Myocarditis

Cited by 54 publications

References 34 publications

Giant Cell Myocarditis: Diagnosis and Treatment

Giant Cell Myocarditis: Diagnosis and Treatment

Giant Cell Myocarditis: A Brief Review

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