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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

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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:

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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.