Usefulness of Rabbit Anti-thymocyte Globulin in Patients With Giant Cell Myocarditis

Suárez-Barrientos, Aida; Wong, Joyce; Bell, Alex; Lyster, Haifa; Karagiannis, Georgios; Banner, Nicholas R.

doi:10.1016/j.amjcard.2015.04.040

Cited by 23 publications

(21 citation statements)

References 25 publications

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“…In children and young adults, intravenous immunoglobulins were also frequently administered. 23 In accordance with recent evidence, 24,25 rabbit antithymocyte globulin (ATG-Fresenius, Bad Homburg, Germany; or thymoglobulin, Genzyme, Cambridge, MA) 1 mg/kg (single dose) was given to treat acute giant-cell myocarditis (GCM), in association with cyclosporine (5 mg/kg daily) and intravenous steroids. Maintenance immunosuppression was given to survivors with a diagnosis of GCM or within the framework of a multisystem autoimmune disorder.…”

Section: Patient Managementmentioning

confidence: 99%

Survival and Left Ventricular Function Changes in Fulminant Versus Nonfulminant Acute Myocarditis

et al. 2017

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Background: Previous reports have suggested that despite their dramatic presentation, patients with fulminant myocarditis (FM) might have better outcome than those with acute nonfulminant myocarditis (NFM). In this retrospective study, we report outcome and changes in left ventricular ejection fraction (LVEF) in a large cohort of patients with FM compared with patients with NFM. Methods: The study population consists of 187 consecutive patients admitted between May 2001 and November 2016 with a diagnosis of acute myocarditis (onset of symptoms <1 month) of whom 55 required inotropes and/or mechanical circulatory support (FM) and the remaining 132 were hemodynamically stable (NFM). We also performed a subanalysis in 130 adult patients with acute viral myocarditis and viral prodrome within 2 weeks from the onset, which includes 34 with FM and 96 with NFM. Patients with giant-cell myocarditis, eosinophilic myocarditis, or cardiac sarcoidosis and those <15 years of age were excluded from the subanalysis. Results: In the whole population (n=187), the rate of in-hospital death or heart transplantation was 25.5% versus 0% in FM versus NFM, respectively ( P <0.0001). Long-term heart transplantation–free survival at 9 years was lower in FM than NFM (64.5% versus 100%, log-rank P <0.0001). Despite greater improvement in LVEF during hospitalization in FM versus NFM forms (median, 32% [interquartile range, 20%–40%] versus 3% [0%–10%], respectively; P <0.0001), the proportion of patients with LVEF <55% at last follow-up was higher in FM versus NFM (29% versus 9%; relative risk, 3.32; 95% confidence interval, 1.45–7.64, P =0.003). Similar results for survival and changes in LVEF in FM versus NFM were observed in the subgroup (n=130) with viral myocarditis. None of the patients with NFM and LVEF ≥55% at discharge had a significant decrease in LVEF at follow-up. Conclusions: Patients with FM have an increased mortality and need for heart transplantation compared with those with NFM. From a functional viewpoint, patients with FM have a more severely impaired LVEF at admission that, despite steep improvement during hospitalization, remains lower than that in patients with NFM at long-term follow-up. These findings also hold true when only the viral forms are considered and are different from previous studies showing better prognosis in FM.

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Section: Patient Managementmentioning

confidence: 99%

Survival and Left Ventricular Function Changes in Fulminant Versus Nonfulminant Acute Myocarditis

et al. 2017

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“…Having excluded an acute coronary syndrome, we confirmed the diagnosis of myocarditis by MRI. A biopsy was required to establish the histological form of myocarditis because treatment depends on the nature of the inflammation …”

Section: Discussionmentioning

confidence: 99%

“…A biopsy was required to establish the histological form of myocarditis because treatment depends on the nature of the inflammation. 5,6 Fulminant necrotizing eosinophilic myocarditis presents as fulminant heart failure; the absence of extra-cardiac involvement distinguishes it from other forms of eosinophilic myocarditis such as hypersensitivity myocarditis (HSM). 7 A recent comprehensive literature review identified 21 published cases of FNEM, in which 15 patients survived and six died.…”

Section: Discussionmentioning

confidence: 99%

Acute fulminant necrotizing eosinophilic myocarditis: early diagnosis and treatment

et al. 2017

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Necrotizing eosinophilic myocarditis is a rare but potentially fatal condition that requires prompt recognition and treatment. We describe a case of a young athlete presenting with chest pain and breathlessness, with evidence of rapidly deteriorating cardiac function. The condition was successfully treated with corticosteroids, with no evidence of residual myocardial damage. This is the first reported case to demonstrate the utility of cardiac magnetic resonance imaging for diagnosis and monitoring response to treatment. It also highlights the value of endomyocardial biopsy in establishing a tissue diagnosis in cases of fulminant myocarditis, in order to direct treatment appropriately.

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“…The present analyses suggest that this therapy had a borderline outcome advantage over use of any other immunosuppressive regimen, but the comparison is subject to limitations due to the study design. Since T lymphocytes are considered instrumental in the immune pathogenesis of GCM, cytolysis of T cells by muromonab‐CD3 or rabbit antithymocyte globulin has been used either additionally to or as a substitute for cyclosporine . In the present work, only one patient was given muromonab‐CD3 because we have used T‐cell ablation as a rescue procedure only.…”

Section: Discussionmentioning

confidence: 99%

Long‐term outcome and its predictors in giant cell myocarditis

Ekström

Lehtonen

Kandolin

et al. 2016

European J of Heart Fail

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Usefulness of Rabbit Anti-thymocyte Globulin in Patients With Giant Cell Myocarditis

Cited by 23 publications

References 25 publications

Survival and Left Ventricular Function Changes in Fulminant Versus Nonfulminant Acute Myocarditis

Survival and Left Ventricular Function Changes in Fulminant Versus Nonfulminant Acute Myocarditis

Acute fulminant necrotizing eosinophilic myocarditis: early diagnosis and treatment

Long‐term outcome and its predictors in giant cell myocarditis

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