A giant mystery in giant cell myocarditis: navigating diagnosis, immunosuppression, and mechanical circulatory support

Fallon, Julianne M.; Parker, Alex M.; Dunn, Steven P.; Kennedy, Jamie L.W.

doi:10.1002/ehf2.12564

Cited by 11 publications

(14 citation statements)

References 20 publications

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“…found that patients with biopsy‐proven inflammatory infiltrate with a diminished coronary reserve due to reduced coronary vasodilator capacity. Fallon et al 12 . showed a histologic image of GCM with a capillary surrounded by the lymphocytic infiltrates, which is also found in our patients ( Figure ).…”

Section: Discussionsupporting

confidence: 86%

Late gadolinium enhancement characteristics in giant cell myocarditis

Chen

Sun

et al. 2021

ESC Heart Failure

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Aims This study aims to demonstrate the characteristics of late gadolinium enhancement (LGE) assessed by cardiovascular magnetic resonance (CMR) imaging in patients with giant cell myocarditis (GCM). Methods and results Six patients histologically diagnosed with GCM were retrospectively recruited in this study. All of them underwent CMR during hospitalization. The distribution and extent of LGE were assessed on both ventricles, and the AHA-17 segment model was used for left ventricular (LV) analysis. Nine case reports with CMR in GCM were reviewed and summarized to investigate the features of LGE further. LGE was detected on both ventricular walls in all subjects. For a detailed analysis of LGE in the LV, the extent ranged from 21.6% to 56%. Among 70 segments (68.6%) involved by LGE, the subendocardial LGE was the most common pattern (46/102, including 24 segments located in the right-sided septum), followed by the subepicardial pattern (23/102). The right-sided septum, the subepicardial anterior wall, and the subendocardial right ventricular (RV) wall were observed in all subjects. To summarize the results of the present study with these case reports, the three most common patterns of LGE are the right-sided septum (73%), the subepicardial anterior wall (60%), and the subendocardial RV wall (53%). Conclusions Extensive LGE seems to be common in GCM, affecting both LV and RV walls. Apart from subepicardial LGE, subendocardial LGE, which was used to be implicated in ischaemic disease, was frequently presented in GCM. The right-sided subendocardial septum, the subepicardial anterior wall, and the subendocardial RV wall might be the vulnerable areas of LGE in GCM.

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Section: Discussionsupporting

confidence: 86%

Late gadolinium enhancement characteristics in giant cell myocarditis

Chen

Sun

et al. 2021

ESC Heart Failure

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“… 2 Choosing the optimal evidence-based immunosuppression regimen for the patients is challenging because there have only been some small case series and observational studies and no randomized clinical trials. 15 In this case, we prescribed only PSL and ciclosporin, not azathioprine. The LV function did not recover.…”

Section: Discussionmentioning

confidence: 94%

Different reverse remodelling between left ventricle and right ventricle in fulminant heart failure due to giant cell myocarditis: a case report

Yokoyama

Yamaguchi

Tobita

et al. 2021

European Heart Journal - Case Reports

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Background Giant cell myocarditis (GCM) is a rare cause of fulminant heart failure (HF). The most common presentation is progressive hemodynamic deterioration, and a few cases present with idiopathic complete atrioventricular block (cAVB). The prognosis of GCM is poor, and GCM patients usually die of HF and ventricular arrhythmia unless cardiac transplantation is performed. Few reports have described the effects of treatments such as immunosuppression and detailed reverse remodelling in GCM patients. Case summary A 69-year-old female presented with cAVB. Transvenous pacemaker was implanted via the left subclavian vein. One and a half months later, she exhibited left ventricular dyssynchrony and lower left ventricular ejection fraction (LVEF), resulting in hospitalization for HF. She received cardiac resynchronization therapy; however, this had no apparently positive effects on her cardiac function. To investigate the cause of the lower LVEF, an endomyocardial biopsy was taken from the right ventricular septum. She was diagnosed with GCM and immediately received immunosuppression therapy with prednisolone and ciclosporin. This resulted in the functional recovery of the right ventricle; on the other hand, the left ventricle had still not recovered based on transthoracic echocardiography. Fortunately, she successfully recovered from severe HF without recurrence. Discussion This is a case of fulminant HF due to GCM which initially presented as cAVB. Moreover, this case demonstrates the quite difference of the functional recovery between the left ventricle and the right ventricle with immunosuppression therapy.

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“…не отмечено ни одного случая развития ГКМ в трансплантированном сердце [18,19]. Сообщается также о повышенном риске острого отторжения у больных с ГКМ в сравнении с ДКМП (16% vs 5%, р = 0,021), однако 1-, 5-и 10-летняя выживаемость не отличается от таковой при иных причинах ТС (94, 82 и 68% соответственно) [20].…”

Section: Discussionunclassified

Verified chronic severe giant cell myocarditis: an inevitable choice for heart transplantation

Благова

Lutokhina

Айнетдинова

et al. 2021

RJTAO

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государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский университет), Москва, Российская Федерация 2 ФГБУ «Национальный медицинский исследовательский центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава России, Москва, Российская Федерация Миокардит имеет полиморфные клинические проявления и является одной из основных причин трансплантации сердца. Приводится описание клинического наблюдения пациентки 43 лет, поступившей в клинику с бивентрикулярной сердечной недостаточностью III-IV ФК. На фоне длительного курения периодически отмечала обострения бронхита. За 21 месяц до госпитализации впервые отметила появление одышки без явной связи с инфекцией, выявлены снижение фракции выброса (ФВ) до 34%, плевральный и перикардиальный выпот. При коронарографии без отклонений от нормы. При МРТ -субэндокардиальное контрастирование верхушки левого желудочка (ЛЖ). Состояние расценивалось как миокардит, в течение полугода проводилась терапия преднизолоном 30 мг/сутки, кардиотропная терапия. Одышка нарастала, присоединились отеки нижних конечностей. При обследовании в клинике: резкое снижение вольтажа комплекса QRS, комплексы QS в отв. V1-V6, дилатация всех камер сердца, выстланная тромбом аневризма верхушки ЛЖ, ФВ 16%, VTI 3,9 см, dp/dt 454 мм рт. ст., резкое повышение титров антикардиальных антител (до 1 : 320). В связи с быстро нараставшей тяжестью состояния, потребностью в кардиотониках, появлением признаков полиорганной недостаточности эндомиокардиальная биопсия не выполнялась. Переведена в ФНЦ им. В.И. Шумакова, где проводилась экстракорпоральная мембранная оксигенация; успешно выполнена ортотопическая ТС. В течение года состояние стабильное. При исследовании эксплантированного сердца выявлена картина гигантоклеточного миокардита. Обсуждаются вопросы диагностики, возможность длительного течения, а также методы лечения данного варианта миокардита, включая ключевую роль ТС.

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A giant mystery in giant cell myocarditis: navigating diagnosis, immunosuppression, and mechanical circulatory support

Cited by 11 publications

References 20 publications

Late gadolinium enhancement characteristics in giant cell myocarditis

Late gadolinium enhancement characteristics in giant cell myocarditis

Different reverse remodelling between left ventricle and right ventricle in fulminant heart failure due to giant cell myocarditis: a case report

Verified chronic severe giant cell myocarditis: an inevitable choice for heart transplantation

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