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Myocarditis in hypertrophic cardiomyopathy patients presenting acute clinical deterioration

Andrea Frustaci1, Romina Verardo, Marina Caldarulo

  • 1Heart and Great Vessels Attilio Reale Department, La Sapienza University, Viale del Policlinico 155, Rome, Italy. biocard@inmi.it

European Heart Journal
|February 21, 2007
PubMed

Insights

Myocarditis, an inflammation of the heart muscle often caused by viruses, frequently leads to acute clinical deterioration in patients with hypertrophic cardiomyopathy (HCM). Identifying myocarditis in HCM patients can improve prognosis and treatment strategies.

Area of Science:

  • Cardiology
  • Pathology
  • Genetics

Background:

  • Hypertrophic cardiomyopathy (HCM) is a genetic heart muscle disease.
  • Acute clinical deterioration in HCM patients can be severe and life-threatening.
  • The role of myocarditis in HCM exacerbations is not well understood.

Purpose of the Study:

  • To investigate the prevalence and impact of myocarditis in patients with hypertrophic cardiomyopathy.
  • To determine if myocarditis is a significant factor in acute electrical instability and clinical decline in HCM.

Main Methods:

  • 119 HCM patients (42 with acute deterioration, 77 stable) underwent cardiac catheterization and endomyocardial biopsy.
  • Biopsies were analyzed for histology, immunohistochemistry, and viral genomes.
  • Gene analysis of sarcomeric proteins was performed; controls had mitral stenosis.

Main Results:

  • Histological findings consistent with HCM were present in all patients.
  • Active myocarditis (CD45RO+ lymphocytes and myocyte necrosis) was found in 28 of 42 unstable HCM patients, but none of the stable patients.
  • Viral genomes were detected in 14 of the 28 myocarditis patients, but not in stable HCM patients or controls.

Conclusions:

  • Viral myocarditis is a common cause of acute clinical deterioration in hypertrophic cardiomyopathy.
  • Recognizing myocarditis in HCM patients is crucial for potentially improving disease prognosis and guiding treatment decisions.
Abstract

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