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Granulomatous myocarditis in severe heart failure patients undergoing implantation of a left ventricular assist

Ana Maria Segura1, Rajko Radovancevic, Zumrut T Demirozu

  • 1Department of Cardiovascular Pathology Research, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, TX.

Cardiovascular Pathology : the Official Journal of the Society for Cardiovascular Pathology
|August 10, 2013
PubMed

Insights

Granulomatous myocarditis is an incidental finding in some patients requiring left ventricular assist device (LVAD) implantation for heart failure. Histological examination of LV samples aids diagnosis and management of this condition.

Area of Science:

  • Cardiology
  • Pathology
  • Transplant Surgery

Background:

  • Granulomatous myocarditis can lead to severe heart failure and necessitate left ventricular assist device (LVAD) implantation.
  • Diagnosis of granulomatous myocarditis is crucial for managing heart failure.
  • LVAD implantation is a critical intervention for end-stage heart failure.

Purpose of the Study:

  • To investigate the prevalence and characteristics of granulomatous myocarditis in patients undergoing LVAD implantation.
  • To assess the diagnostic utility of LV core sample histology in identifying granulomatous myocarditis.
  • To evaluate the clinical course and outcomes of patients with incidentally diagnosed granulomatous myocarditis.

Main Methods:

  • Histological examination of left ventricular (LV) core samples from 177 patients undergoing LVAD implantation.
  • Grading of myocardial hypertrophy and fibrosis.
  • Staining and culturing for mycobacteria and fungi to rule out infectious causes.
  • Analysis of clinical parameters and patient outcomes post-LVAD implantation.

Main Results:

  • Granulomatous myocarditis was incidentally found in 3.4% (6/177) of LV core samples.
  • Infectious causes (mycobacteria, fungi) were ruled out by negative stains and cultures.
  • Patients with granulomatous myocarditis experienced arrhythmias and required defibrillators, with significant pre-LVAD cardiac dysfunction.
  • Outcomes included heart transplantation and continued LVAD support, with no evidence of recurrence or extra-cardiac involvement.

Conclusions:

  • Histological examination of LV core samples during LVAD implantation can incidentally diagnose granulomatous myocarditis.
  • This diagnosis can inform the management of the underlying cause of heart failure.
  • LV core sample analysis is a valuable diagnostic tool in select heart failure patients.
Abstract

Keywords:
Granulomatous myocarditisHeart failureLVADSarcoidosis

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