Management of Patients With Giant Cell Myocarditis

Bang, Vigyan; Ganatra, Sarju; Shah, Sachin; Dani, Sourbha S.; Neilan, Tomas G.; Thavendiranathan, Paaladinesh; Resnic, Frederic S.; Piemonte, Thomas C.; Barac, Ana; Patel, Rushin; Sharma, Ajay; Parikh, Rohan; Chaudhry, Ghulam M.; Vesely, Mark R.; Hayek, Salim S.; Leja, Monika; Venesy, David M.; Patten, Richard D.; Lenihan, Daniel J.; Nohria, Anju; Cooper, Leslie T.

doi:10.1016/j.jacc.2020.11.074

Cited by 68 publications

(92 citation statements)

References 41 publications

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“…36 However, outcomes have significantly improved in recent years with the use of immunosuppressive therapy and there is now a significantly reduced need for mechanical support and/or cardiac transplantation in patients with giant-cell myocarditis. 37 These interventions are still required in certain cases and postcardiac transplant survival for giant-cell myocarditis is 94% at 1 year, 82% at 5 years and 68% at 10 years (similar to other aetiologies of myocarditis). 37 However, 20-25% of patients develop a recurrence of giant-cell myocarditis even after cardiac transplantation (which is often asymptomatic and detected on surveillance endomyocardial biopsy) thus typically requiring further immunosuppression.…”

Section: Acute Myocarditismentioning

confidence: 99%

“…37 These interventions are still required in certain cases and postcardiac transplant survival for giant-cell myocarditis is 94% at 1 year, 82% at 5 years and 68% at 10 years (similar to other aetiologies of myocarditis). 37 However, 20-25% of patients develop a recurrence of giant-cell myocarditis even after cardiac transplantation (which is often asymptomatic and detected on surveillance endomyocardial biopsy) thus typically requiring further immunosuppression. 37…”

Section: Acute Myocarditismentioning

confidence: 99%

“…37 However, 20-25% of patients develop a recurrence of giant-cell myocarditis even after cardiac transplantation (which is often asymptomatic and detected on surveillance endomyocardial biopsy) thus typically requiring further immunosuppression. 37…”

Section: Acute Myocarditismentioning

confidence: 99%

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Acute myocarditis: aetiology, diagnosis and management

et al. 2021

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Acute myocarditis is a serious, likely underdiagnosed condition affecting people of all ages and for which the number of UK hospital admissions is rising. A primary diagnosis of myocarditis accounted for 0.04% (36.5 per 100,000) of all hospital admissions in England between 1998 and 2017, although this is likely to be an underestimate of the true burden of myocarditis. The aetiology is broad, including infective and inflammatory conditions as well as exposure to toxic agents. Clinical features are varied and overlap with other acute cardiac conditions making diagnosis a challenge. Cardiovascular magnetic resonance imaging currently serves as the gold standard non-invasive diagnostic modality. If an underlying aetiological process is identified, then therapy may be directed at the cause; however, for most, treatment is supportive and aimed at managing any complications such as heart failure or arrhythmias. There is emerging evidence for immunosuppressive therapy in certain cases. Prognosis is generally good with recovery in most; however, up to 30% with biopsy-proven myocarditis progress to develop a dilated cardiomyopathy and its potential associated complications. All-cause mortality in the UK for patients presenting to hospital with acute myocarditis is approximately 4%.

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Section: Acute Myocarditismentioning

confidence: 99%

Section: Acute Myocarditismentioning

confidence: 99%

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Acute myocarditis: aetiology, diagnosis and management

et al. 2021

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“…Earlier research found that combination immunosuppressive therapy including cyclosporine prolongs median transplant-free survival from 3.0 to 12.4 months for patients with GCM ( 12 ). Though we were aware that the application of immunosuppressive therapy could significantly improve the prognoses of GCM ( 41 ), a small proportion of patients with FGCM were treated with glucocorticoids in our study. This might be explained by the fact that most of the patients with FGCM were misdiagnosed as other diseases before heart transplantations.…”

Section: Discussionmentioning

confidence: 96%

Fulminant Giant Cell Myocarditis vs. Lymphocytic Myocarditis: A Comparison of Their Clinical Characteristics, Treatments, and Outcomes

Ren²,

Dong

et al. 2021

Front. Cardiovasc. Med.

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Objectives: Fulminant myocarditis (FM) is a rapidly progressive and frequently fatal form of myocarditis that has been difficult to classify. This study aims to compare the clinical characteristics, treatments and outcomes in patients with fulminant giant cell myocarditis (FGCM) and fulminant lymphocytic myocarditis (FLM).Methods and Results: In our retrospective study, nine patients with FGCM (mean age 47.9 ± 7.5 years, six female) and 7 FLM (mean age 42.1 ± 12.3 years, four female) patients confirmed by histology in the last 11 years were included. Most patients with FGCM and FLM were NYHA functional class IV (56 vs. 100%, p = 0.132). Patients with FGCM had significantly lower levels of high-sensitivity C-reactive protein [hs-CRP, 4.4 (2.0–10.2) mg/L vs. 13.6 (12.6–14.6) mg/L, P = 0.004, data shown as the median with IQR], creatine kinase-myoglobin [CK-MB, 1.4 (1.0–3.2) ng/ml vs. 14.6 (3.0–64.9) ng/ml, P = 0.025, median with IQR], and alanine aminotransferase [ALT, 38.0 (25.0–61.5) IU/L vs. 997.0 (50.0–3,080.0) IU/L, P = 0.030, median with IQR] and greater right ventricular end-diastolic diameter (RVEDD) [2.9 ± 0.3 cm vs. 2.4 ± 0.6 cm, P = 0.034, mean ± SD] than those with FLM. No differences were observed in the use of intra-aortic balloon pump (44 vs. 43%, p = 1.000) and extracorporeal membrane oxygenation (11 vs. 43%, p = 0.262) between the two groups. The long-term survival rate was significantly lower in FGCM group compared with FLM group (0 vs. 71.4%, p = 0.022). A multivariate cox regression analysis showed the level of hs-CRP (hazard ratio = 0.871, 95% confidence interval: 0.761–0.996, P = 0.043) was an independent prognostic factor for FM patients. Furthermore, the level of hs-CRP had a good ability to discriminate between patients with FGCM and FLM (AUC = 0.94, 95% confidence interval: 0.4213–0.9964).Conclusions: The inflammatory response and myocardial damage in the patients with FGCM were milder than those with FLM. Patients with FGCM had distinctly poorer prognoses compared with those with FLM. Our results suggest that hs-CRP could be a promising prognostic biomarker and a hs-CRP level of 11.71 mg/L is an appropriate cutoff point for the differentiating diagnosis between patients with FGCM and FLM.

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“…Although, currently it has been considered as an established etiology of myocarditis, there is no clear recommendation and consensus regarding the best clinical approach and the management of myocarditis following COVID-19. [6][7][8][10][11][12][13] Here, we reported, a case of GCM following COVID-19 infection. Recently, Blagova et al have reported a cardiomyopathy that was rapidly progressed to a sudden cardiac death following COVID -19 in a patient with a history of chronic adrenal insufficiency and myocardial disease with a final diagnosis GCM.…”

Section: Cmr Reportmentioning

confidence: 99%