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Histologically proven myocarditis in patients with biventricular dysfunction and severe asymptomatic coronary artery

C Chimenti1, A Frustaci, M Pieroni

  • 1Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma.

Cardiologia (Rome, Italy)
|April 20, 1999
PubMed

Insights

Severe coronary artery disease may cause biventricular dysfunction through myocarditis, not ischemia. Immunosuppressive therapy improved cardiac function in patients with this condition.

Area of Science:

  • Cardiology
  • Pathology

Background:

  • Biventricular dysfunction in patients with critical coronary artery stenosis and no myocardial ischemia or infarction is not fully understood.
  • Severe coronary artery disease (CAD) can present with heart failure symptoms despite the absence of ischemic events.

Purpose of the Study:

  • To investigate the pathogenesis of global biventricular dysfunction in patients with severe asymptomatic coronary artery disease.
  • To determine if myocarditis, rather than ischemia or hibernation, is the cause of biventricular dysfunction in these patients.

Main Methods:

  • Retrospective analysis of 7 patients with severe CAD and biventricular dysfunction undergoing endomyocardial biopsy.
  • Evaluation of cardiac function using two-dimensional echocardiography and histological examination of myocardial tissue.
  • Assessment of treatment response to immunosuppressive therapy (prednisone and azathioprine) versus conventional therapy.

Main Results:

  • All 7 patients exhibited severe coronary artery disease and biventricular dysfunction.
  • Histological analysis revealed lymphocytic infiltrates and myocytolysis consistent with myocarditis in all patients.
  • Patients treated with immunosuppressive therapy showed significant improvement in cardiac volume and function (ejection fraction) at 6-month follow-up, unlike conventionally treated patients.

Conclusions:

  • Global biventricular dysfunction in severe asymptomatic coronary artery disease may be attributed to myocarditis.
  • Immunosuppressive therapy can improve cardiac function in patients with CAD-associated myocarditis.
  • Myocarditis should be considered in the differential diagnosis of biventricular dysfunction in patients with severe coronary artery disease without a history of myocardial infarction.

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