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Miocarditis atrial de células gigantes: una entidad clínico patológica distintiva
Brandon T Larsen1, Joseph J Maleszewski, William D Edwards
1Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
Circulation
|November 28, 2012
Resumen
La miocarditis de células gigantes (MGC) puede afectar las aurículas, presentándose de manera diferente a la MGC ventricular típica. Esta variante auricular muestra un pronóstico más favorable y características clínicas distintas.
Área de la Ciencia:
- Cardiología Cardiología.
- Patología Patología Patología.
- Inmunología Inmunología.
Sus antecedentes:
- La miocarditis de células gigantes (MGC) generalmente se presenta como insuficiencia cardíaca fulminante, lo que requiere un tratamiento agresivo.
- Se ha identificado una nueva variante de GCM que afecta principalmente a las aurículas.
- Esta variante de CMG auricular exhibe características clínicas distintas y un curso clínico más benigno.
Objetivo del estudio:
- Describir las características clínico-patológicas de una nueva variante de miocarditis de células gigantes que afecta predominantemente a las aurículas.
- Para diferenciar esta GCM auricular de la clásica GCM ventricular basada en la presentación clínica, las imágenes y la histología.
- Para evaluar el curso clínico y los resultados de los pacientes diagnosticados con GCM atrial.
Principales métodos:
- Revisión retrospectiva de 6 pacientes diagnosticados con GCM auricular entre 2010 y 2012.
- Análisis de la historia clínica, ecocardiografía y hallazgos histopatológicos de tejido auricular resecado quirúrgicamente.
- Evaluación de las estrategias de tratamiento y datos de seguimiento del paciente.
Principales resultados:
- Los pacientes presentaron fibrilación auricular, insuficiencia cardíaca o fueron encontrados incidentalmente en la autopsia.
- La ecocardiografía reveló dilatación auricular severa, regurgitación mitral / tricúspide y anomalías de la pared auricular, con función ventricular preservada.
- La histología mostró infiltraciones de células gigantes y linfocitos, necrosis / hipertrofia de cardiomiocitos, fibrosis y granulomas.
Conclusiones:
- La CMG auricular es una entidad clínico patológica distinta con un pronóstico más favorable que la CMG ventricular.
- Esta condición debe considerarse en el diagnóstico diferencial de la dilatación auricular, especialmente con el engrosamiento asociado de la pared auricular.
- La eficacia de la terapia inmunomoduladora para la GCM auricular requiere más investigación.
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