Long‐term outcome and its predictors in giant cell myocarditis

Abstract

In GCM, the probability of transplant-free survival is 42% at 5 years from symptom onset. Markers of myocyte injury and cardiac dysfunction help predict the outcome.

Cardiac Autoimmunity: Myocarditis

“…The latter chronic damage corresponds to development of dilated cardiomyopathy (DCM). Its overall incidence among myocarditis cases is not accurately known, but retrospective studies report that 9–16% of unexplained nonischemic DCM cases have histological evidence of myocarditis, thus suggesting a persistent/self-sustained autoimmune inflammatory progression as a requirement [4, 7, 9, 10]. Other studies estimate a wider range of 10–50% of DCM cases having evidence of myocarditis as could be determined by endomyocardial biopsy [11].…”

Incidence, Risk Factors, and Outcome of Life-Threatening Ventricular Arrhythmias in Giant Cell Myocarditis

“…6,10 In short, medical records were reviewed for patient demographics, comorbidities, main clinical manifestations, results of laboratory tests and imaging studies, as well as for the details of treatment with drugs and devices. The methods to measure plasma concentrations of N-terminal brain natriuretic propeptide (NT-proBNP) and cardiac troponin T (cTnT) have also been described earlier 10 as have been the methods used to assess cardiac studies with contrast-enhanced magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography (PET). 11 For the present work, MRI studies were reviewed for the presence of pathological myocardial late gadolinium enhancement (LGE) (yes/no) and the PET studies for the presence of abnormal focal myocardial 18F-fluorodeoxyglucose accumulation, suggestive of active inflammation (yes/no).…”

“…The extent of cardiomyocyte necrosis and the number of eosinophils were graded visually from hematoxylin-eosin-stained samples using a semiquantitative 4-point scale (0, 1, 2, and 3 for none, mild, moderate, and severe, respectively) as detailed earlier with supporting illustrations. 10 The presence and extent of myocardial fibrosis was scored in similar manner from slices stained with Masson's trichrome. All scores were based on the pathologists' consensus.…”

“…We have included all GCM patients seen at our institution since 1991 in a cumulative registry study 6,10 that currently goes on prospectively. Our latest publication focused on transplant-free survival in GCM and showed that patients receiving immunosuppressive treatment had a 48% 5-year survival, with markers of myocardial injury being predictive of outcome.…”

“…Our latest publication focused on transplant-free survival in GCM and showed that patients receiving immunosuppressive treatment had a 48% 5-year survival, with markers of myocardial injury being predictive of outcome. 10 Because as many as four fifths of cardiac deaths appeared to have an arrhythmic mechanism, 10 we set out to analyze in detail the occurrence of life-threatening ventricular arrhythmias in GCM. Here we describe their incidence and risk factors, as well as observations on their outcome with treatment, in consecutive GCM patients seen at our hospital over the last 25 years.…”