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Methylprednisolone in chronic myocarditis
U Jühl1, B E Strauer, H P Schultheiss
1Med. Klinik für Kardiologie, Pulmonologie und Angiologie, Heinrich-Heine Universität Düsseldorf, Germany.
Postgraduate Medical Journal
|January 1, 1994
Summary
Immunosuppressive treatment improved dilated cardiomyopathy in patients with active inflammation. Immunohistology identified myocarditis, leading to better clinical and hemodynamic outcomes in 60-70% of treated individuals.
Area of Science:
- Cardiology
- Immunology
- Pathology
Background:
- Dilated cardiomyopathy etiology is often unknown, with viral myocarditis a suspected contributor.
- Current diagnostic methods for myocarditis via endomyocardial biopsy have limitations in differentiating inflammatory cells.
Purpose of the Study:
- To evaluate the efficacy of immunohistological methods for diagnosing myocarditis in dilated cardiomyopathy.
- To assess the impact of immunosuppressive treatment on patients with immunohistologically confirmed active myocarditis.
Main Methods:
- Endomyocardial biopsies were analyzed using immunohistological techniques to identify and quantify inflammatory lymphocytes.
- Patients with confirmed active myocarditis underwent a 6-month treatment with 6-methylprednisolone.
- Clinical (NYHA classification), hemodynamic (ejection fraction, stroke volume, LVEDP), and histological parameters were assessed before and after treatment.
Main Results:
- Myocarditis was diagnosed in 37% (48/130) of patients via immunohistology.
- Following treatment, 23 patients improved clinically, and lymphocytic infiltrates resolved in 24 patients.
- Left ventricular systolic function improved in 64% (20/31) of treated patients.
Conclusions:
- Immunohistology is valuable for diagnosing active myocarditis in dilated cardiomyopathy.
- Immunosuppressive therapy can lead to significant clinical, hemodynamic, and histological improvement in a subset of patients with active inflammatory processes.
- Treatment response appears limited in patients with severely impaired left ventricular function.