High incidence of myocarditis by endomyocardial biopsy in patients with idiopathic congestive cardiomyopathy

Zee-Cheng, Chi-Sung; Tsai, Chun-Chin; Palmer, Diane C.; Codd, John E.; Pennington, D. Glenn; Williams, George A.

doi:10.1016/s0735-1097(84)80431-3

Cited by 201 publications

(44 citation statements)

References 18 publications

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“…[12][13][14][15][16] incidence of myocarditis in peripartum cardiomyopathy has been reported to be between 29% and 100%.7,17,18 We have seen myocarditis in 14 of 18 patients (78%) with this disease; several reasons for this apparent discrepancy in the frequency of myocarditis may exist.…”

Section: Discussionmentioning

confidence: 83%

Peripartum myocarditis and cardiomyopathy.

et al. 1990

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The clinical and pathologic features of 18 consecutive patients with peripartum cardiomyopathy at The Johns Hopkins Hospital were examined in an attempt to define the incidence of myocarditis and to determine its response to immunosuppressive agents. In addition to routine studies, patients were evaluated with echocardiography, nuclear ventriculography, right heart catheterization, and myocardial biopsy. Fourteen of the 18 patients (78%) showed evidence of myocarditis. Of these, 10 were treated with immunosuppressive therapy. Nine of the 10 treated patients with myocarditis had subjective and objective improvement. Follow-up endomyocardial biopsies in these patients showed resolution or substantial improvement in myocarditis. Four patients with myocarditis not treated with immunosuppressives also improved. All patients improving spontaneously presented with congestive heart failure within 1 month of delivery and improved dramatically within days of presentation. Four of the 18 patients showed no evidence of myocarditis. Of these, two improved, and two deteriorated (both requiring cardiac transplantation). None of these four patients were treated with immunosuppressive therapy. We conclude that in patients with peripartum cardiomyopathy, 1) the etiology remains unclear although myocarditis was present in 78% of those with this condition, 2) resolution of myocarditis is associated with significant improvement in left ventricular function, 3) myocarditis may resolve spontaneously without detectable loss of cardiac function, and 4) immunosuppressive therapy in patients with myocarditis and persistent left ventricular dysfunction may improve left ventricular function and prognosis. (Circulation 1990;81:922-928) T he onset of unexplained dilated cardiomyopathy occurring for the first time during the last month of pregnancy or within 5 months after delivery has been termed peripartum cardiomyopathy.' The disorder is rare, occurring approximately once in every 2,500 deliveries'-3 and comprises less than 1% of pregnancy-associated cardiovascular abnormalities.

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Section: Discussionmentioning

confidence: 83%

Peripartum myocarditis and cardiomyopathy.

et al. 1990

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“…In none of the patients was the mean number of T lymphocytes greater than 6.0 per square mm of myocardial tissue. The absence of myocarditis in our study population could be due to the fact that we included only patients with end-stage heart disease, whereas Zee-Cheng et al [28], Parrillo et al [17], and Kiihl et al [lo] examined endomyocardial biopsies of patients in an earlier phase of heart disease.…”

Section: Discussionmentioning

confidence: 99%

Histopathologic findings in explanted heart tissue from patients with end-stage idiopathic dilated cardiomyopathy

Leeuw¹,

Ruiter²,

Balk³

et al. 2001

Transplant Int

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Explanted hearts were examined to determine whether specific histopathologic features are present in the myocardium of patients with end‐stage idiopathic dilated cardiomyopathy (IDC). Extensive histopathologic examination by light microscopy, electron microscopy and immunohistochemistry revealed marked fibrosis in the hearts of 21 of 37 IDC patients and in 26 of 35 patients with heart diseases of known causes. Reactive (interstitial and perivascular) fibrosis predominated in the IDC hearts, whereas both reparative (replacement) fibrosis and reactive fibrosis were found in the comparison group. Endocardial fibroelastosis was found in nine patients with IDC and in 14 patients from the comparison group. Distinct patterns of fibrosis were the sole significant histopathologic difference between myocardial samples from patients with IDC and from those with heart diseases of known causes. The diffuse presence of reactive fibrosis in IDC patients suggests a more generalised dysfunction that affects the composition of the myocardial extracellular matrix.

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“…The etiology of this condition is unknown and is probably multifactorial. Endomyocardial biopsy studies in some patients considered clinically to have IDC have reported a substantial incidence of inflamatory myocarditis and viral infection has also been implicated in the etiology [5].…”

Section: Discussionmentioning

confidence: 99%

“…It usually has a poor prognosis in children and adolescents. Conservative management with aggressive decongestive therapy may help in symptomatic improvement but very rarely it will result in normalization of systolic function [5] . The only hope for prolonged survival is cardiac transplantation.…”

Section: Discussionmentioning

confidence: 99%

IDIOPATHIC INFANTILE CARDIOMYOPATHY (A Case Report)

Bhatia

1998

Medical Journal Armed Forces India

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High incidence of myocarditis by endomyocardial biopsy in patients with idiopathic congestive cardiomyopathy

Cited by 201 publications

References 18 publications

Peripartum myocarditis and cardiomyopathy.

Peripartum myocarditis and cardiomyopathy.

Histopathologic findings in explanted heart tissue from patients with end-stage idiopathic dilated cardiomyopathy

IDIOPATHIC INFANTILE CARDIOMYOPATHY (A Case Report)

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