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[Long-term observation of patients with biopsy proven myocarditis or dilated cardiomyopathy]
M Olszowska1, W Tracz, M Kokoszka
1Kliniki Chorób Serca i Naczyń Collegium Medicum Uniwersytetu Jagiellońiskiego w Krakowie.
Insights
Immunosuppressive therapy improved outcomes for patients with myocarditis (MCD), though some experienced later deterioration. Dilated cardiomyopathy (DC) patients showed poor survival and advanced heart failure. Echocardiographic improvements correlated with better clinical status in both groups.
Area of Science:
- Cardiology
- Immunology
- Pathology
Context:
- Dilated cardiomyopathy (DC) and myocarditis (MCD) are cardiac diseases with unknown causes and pathogenesis.
- The natural history and treatment of MCD remain controversial.
- Congestive heart failure symptoms were prevalent in the observed patients.
Purpose:
- To evaluate the long-term outcomes of patients with biopsy-proven MCD and DC.
- To assess the efficacy of immunosuppressive therapy in MCD.
- To correlate echocardiographic parameters with clinical status.
Summary:
- Thirty patients with biopsy-proven MCD received immunosuppressive agents (azathioprine and prednisone) along with standard heart failure medications.
- Fifteen patients with DC received standard heart failure management.
- Outcomes including survival and New York Heart Association (NYHA) class were monitored.
- Clinical improvement was noted in 93% of MCD patients within 6 months, with 20% deteriorating later.
- 16 out of 30 MCD patients remained in lower NYHA classes (I-II) during long-term follow-up (26-69 months).
- 28% of DC patients died within the first year, and 14 out of 15 survivors presented with advanced heart failure (NYHA III-IV).
- Echocardiographic parameters did not significantly differ between groups but showed correlation with clinical status improvement.
Impact:
- Immunosuppressive therapy shows potential benefit in managing myocarditis, improving long-term clinical status for a subset of patients.
- Dilated cardiomyopathy presents a poor prognosis with high mortality and advanced heart failure.
- Echocardiographic improvements serve as a reliable indicator of clinical recovery in patients with these cardiac conditions.
Abstract:
Dilated cardiomyopathy (DC) and myocarditis (MCD) are still cardiac diseases of unknown etiology and pathogenesis. Due to uncertain natural history of MCD also treatment remains controversial. We observe long-term outcome of 30 pts with biopsy-proved MCD (group I) and 25 pts with DC (group II). The diagnosis of MCD was established on Dallas criteria of MCD. Almost all pts presented symptoms of congestive heart failure. All group I pts were treated with immunosuppressive agents: azathioprine 1.5 mg/kg/d and prednisone with initial dose of 1.5 mg/kg/d. After tapering off 0.75 mg/kg/d of prednisone and initial dose of azathioprine were given up to 6 months. All pts obtained digitalis, diuretics, ACEI, antiarrhythmic drugs if necessary. We studied the survival and clinical status (NYHA class) of treated pts. Clinical improvement was observed in 93% of pts with MCD within 6 months, but 20% of pts deteriorated within the next 6 months. Almost all pts survived 1 year. Out of 30 pts with MCD, 16 pts remain in lower NYHA class (NYHA I-II) between 26 and 69 months of follow-up. Within the group II (DC) 28% of pts died in the first year of observation. Out of 15 pts in 14 pts advanced chronic heart failure (NYHA III-IV) is presented in the end of observation. Echocardiographic parameters of pts with congestive heart failure and biopsy-proved MCD or DC did not differ significantly. We observed correlation between improvement of the LV echocardiographic parameters and improvement of clinical status of treated pts.