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Active versus borderline myocarditis: clinicopathological correlates and prognostic implications.
A Angelini1, M Crosato, G M Boffa
1Department of Pathology, University of Padua Medical School, Padua, Italy.
Heart (British Cardiac Society)
|February 16, 2002
Summary
Active (AM) versus borderline (BM) myocarditis shows distinct clinical and pathological features. Borderline myocarditis may represent a chronic inflammatory process, with viral genome absence predicting a better prognosis.
Area of Science:
- Cardiology
- Pathology
- Infectious Diseases
Background:
- Myocarditis, inflammation of the heart muscle, is classified histologically.
- Distinguishing between active (AM) and borderline (BM) myocarditis may offer prognostic insights.
Purpose of the Study:
- To compare active (AM) and borderline (BM) myocarditis.
- To determine if pathological differences correlate with clinical, hemodynamic characteristics, and prognosis.
Main Methods:
- Retrospective review of 42 patients diagnosed with myocarditis via endomyocardial biopsy (EMB).
- Analysis included immunohistochemistry and polymerase chain reaction (PCR) for viral genomes.
- Clinicopathological correlations were assessed.
Main Results:
- Active myocarditis (AM) showed less left bundle branch block and smaller left ventricular volumes compared to borderline myocarditis (BM).
- BM cases had a longer interval to EMB and less intense inflammatory infiltrates.
- Viral genomes were detected in 40% of AM and 25% of BM cases; absence of viral genome predicted better outcomes.
Conclusions:
- Borderline myocarditis (BM) may represent a chronic inflammatory condition leading to left ventricular dilatation.
- "Chronic myocarditis" may be a more fitting term for BM.
- Absence of myocyte necrosis does not guarantee a favorable prognosis, but absence of viral detection does.