Lymphocytic myocarditis and dilated cardiomyopathy: treatment with immunosuppressive agents

Viral myocarditis—diagnosis, treatment options, and current controversies

“…Although some investigators were optimistic after the results of several small observational studies, the high incidence of clinical improvement with standard heart failure treatment and substantial rate of spontaneous improvement in LV function substantiated the need for a control arm to evaluate treatment efficacy properly. 67 Accordingly, we will focus on the large randomized, controlled clinical trials reporting on the use of im munosuppressive therapy ( Table 1). …”

Myocarditis

“…50 Although Ͼ20 uncontrolled observational studies have reported success with the use of a variety of immunosuppressive agents, 109,110 several caveats should be emphasized. First, histological resolution of myocardial inflammation does not closely correlate with improvement in ventricular function.…”

Treatment of Inflammatory Dilated Cardiomyopathy and (Peri)Myocarditis with Immunosuppression and i.v. Immunoglobulins

“…Corticosteroids can stabilize the membrane of cardiac cells and suppress the immunoreaction pharmacologically through various mechanisms. Common recommendations for corticoid treatment are prednisone and dexamethasone [8,14,19,21,28,30,33,34,59,52]. The application of corticosteroids as immunosuppressive drug is a matter of controversy [20,21,40,52,54].…”

“…A number of retrospective analyses of immunosuppression in myocarditis [8,9,13,19] and the below listed quasi-controlled or truly controlled trials [14,20] showed some benefit of surrogate parameters (ejection fraction, exercise tolerance) but improvement under conventional heart failure treatment cannot be ruled out as the main cause for amelioration due to the small number of patients and controls in many reports. Some of the studies deserve additional comments.…”