Detailed pathologic evaluation on endomyocardial biopsy provides long-term prognostic information in patients with
Jong-Chan Youn1, Hyo Sup Shim2, Jae Seok Lee2
1Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Insights
Detailed pathology of endomyocardial biopsies (EMB) offers prognostic insights for acute myocarditis. Lymphocytic myocarditis and fibrosis in borderline cases indicate poorer outcomes, guiding clinical decisions.
Area of Science:
- Cardiology
- Pathology
- Immunology
Background:
- Long-term prognosis for biopsy-proven myocarditis remains unclear.
- Acute myocarditis diagnosis relies on endomyocardial biopsy (EMB).
- Hypothesis: Detailed EMB pathology predicts patient outcomes.
Purpose of the Study:
- To investigate the prognostic value of detailed pathological examination of EMB in acute myocarditis patients.
- To correlate specific pathological findings with long-term clinical outcomes.
Main Methods:
- Fifty-four acute myocarditis patients underwent EMB analysis.
- Pathological subtypes: lymphocytic dominant, eosinophilic dominant, borderline myocarditis.
- Immunohistochemistry performed for cellular markers, viral proteins, and apoptosis; Masson's trichrome for fibrosis.
Main Results:
- Over 10.4 years, all-cause mortality was 20.4%, cardiovascular (CV) mortality was 14.8%.
- Lymphocytic myocarditis associated with significantly higher all-cause and CV mortality compared to eosinophilic myocarditis.
- Fibrosis in borderline myocarditis linked to poor prognosis for both all-cause and CV mortality.
Conclusions:
- Detailed EMB pathological evaluation provides crucial prognostic information for acute myocarditis.
- EMB assessment aids in identifying patients at higher risk.
- Consider EMB evaluation for suspected myocarditis cases to inform prognosis.
Background:
The long-term prognosis of biopsy-proven myocarditis is not well known. We hypothesized that a detailed pathological examination of an endomyocardial biopsy (EMB) would reveal prognostic information in patients with acute myocarditis.
Methods:
Fifty-four patients were diagnosed with acute myocarditis based on an EMB. Pathological diagnosis was categorized into lymphocytic dominant (29.6%), eosinophilic dominant (22.2%), and borderline myocarditis (48.1%). Masson's trichrome staining and further immunohistochemical staining for CD3, CD20, CD68, HLA-DR, TLR4, TLR8, enteroviral VP1, and caspase-3 expression were performed. The clinical outcomes were defined as all-cause and cardiovascular (CV) death.
Results:
During the median 10.4 years of follow up (9.7±5.7 years), the overall all-cause mortality was 20.4% and the CV mortality was 14.8% in patients with acute myocarditis. Lymphocytic dominant myocarditis patients showed a poor clinical outcome when compared with eosinophilic dominant myocarditis patients for both all-cause (37.5% vs. 0%, p=0.015) and CV (31.2% vs. 0%, p=0.029) mortality. Among borderline myocarditis patients, the presence of fibrosis was linked with poor clinical outcomes in both all-cause (75.0% vs. 21.4%, p=0.045) and CV (100.0% vs. 25.0%, p=0.034) mortality. No significant associations between clinical outcome and all other immunohistochemical staining targets were observed.
Conclusions:
Detailed pathological evaluation on an EMB provides prognostic information in patients with acute myocarditis. EMB evaluation should be considered in patients with suspected myocarditis.
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