Exploring Strategies to Improve Outcomes in Patients With Giant Cell Myocarditis: A Case Series of Five Biopsy-Proven
Minjung Bak1, Jinyoung Lee1, Minseok Hong1
1Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Insights
Giant cell myocarditis (GCM) is a severe heart condition. Early diagnosis and treatment, including mechanical circulatory support, can improve outcomes for some patients, but recurrence after heart transplantation remains a challenge.
Area of Science:
- Cardiology
- Immunology
- Pathology
Background:
- Giant cell myocarditis (GCM) is a rare, severe cardiac disease with high mortality.
- Outcomes for GCM are often poor, necessitating heart transplantation (HT) with a significant risk of recurrence.
Observation:
- This case series analyzed five biopsy-confirmed GCM patients (2004-2024).
- Patients presented with fulminant heart failure, requiring advanced circulatory support.
- Forty percent had pre-existing autoimmune diseases.
Findings:
- Early diagnosis and targeted immunosuppressive therapy improved outcomes in select GCM cases.
- Two patients achieved long-term survival without recurrence.
- Outcomes varied, with some patients recovering, others succumbing to infection, and two dying post-heart transplantation due to complications.
Implications:
- Timely histologic confirmation is crucial for GCM diagnosis.
- Early immunosuppressive therapy and appropriate mechanical circulatory support (MCS) are vital for managing GCM.
- Further research with larger cohorts is needed to validate prognostic strategies for GCM.
Abstract:
Giant cell myocarditis (GCM) is a rare but severe disease with high morbidity and mortality, often requiring heart transplantation (HT). While immunosuppressive therapy has improved outcomes, recurrence after HT remains high, and long-term survival without transplantation is also limited. This case series presents five biopsy-confirmed GCM cases, highlighting clinical characteristics and strategies to improve prognosis. A retrospective analysis was conducted on five GCM patients at Samsung Medical Center (2004-2024). The median age was 57.8 years, and 40% had underlying autoimmune diseases. All patients presented with fulminant heart failure, requiring vasopressor support or mechanical circulatory support (MCS). Early diagnosis facilitated targeted therapy, improving outcomes in select cases. Two patients achieved long-term survival without recurrence. One patient recovered cardiac function and avoided in-hospital mortality but was later readmitted due to infection and subsequently died. The remaining two patients underwent HT but died during hospitalization due to post HT complications. Timely histologic confirmation, early immunosuppressive therapy, and appropriate MCS bridging are critical in GCM management. Larger studies are needed to validate these findings.
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