Circulation, Vol 83, 953-961, Copyright © 1991 by American Heart Association
R Davidoff, I Palacios, J Southern, JT Fallon, J Newell and GW Dec
BACKGROUND. Giant cell myocarditis has rarely been diagnosed premortem, and
little is known about its natural history. In addition, no comparative
studies with lymphocytic myocarditis exist. METHODS AND RESULTS. The
clinical features, serial change in left ventricular fraction (LVEF), and
outcomes of all patients with histologically verified myocarditis were
retrospectively evaluated. Ten patients (22%) were found to have giant cell
myocarditis (group 1), whereas the remaining 36 (78%) had lymphocytic
myocarditis (group 2). Age at presentation, gender distribution, duration
of symptoms, initial LVEF, and resting hemodynamics did not differ between
groups. Ventricular tachycardia was detected in 90% of group 1 patients
compared with only 25% of group 2 (p = 0.0007). Atrioventricular block that
required pacemaker insertion was also more common in group 1 (60%) than in
group 2 (8.3%) (p = 0.001). Left ventricular systolic function declined
during follow-up in group 1 patients (LVEF, 0.43 +/- 0.07-0.26 +/- 0.05, p
= 0.11) but increased in group 2 patients (LVEF, 0.33 +/- 0.03- 0.41 +/-
0.03, p = 0.02). When the net change between initial and final LVEF was
assessed, a significant difference was evident (giant cell group, -0.17 +/-
0.06; lymphocytic group, +0.07 +/- 0.03; p = 0.0008). Although a greater
proportion of patients in group 1 died or required transplantation (seven
of 10 versus 11 of 36, p = 0.03), actuarial survival over 4 years was not
different for the giant cell group (50%) than for the lymphocytic group
(62%). CONCLUSION. Giant cell myocarditis was more prevalent than
previously recognized and highly associated with both ventricular
tachycardia and pacemaker requirement. The likelihood of an adverse event,
either cardiovascular mortality or cardiac transplantation, was
significantly greater for patients with giant cell myocarditis than for
those with lymphocytic myocarditis, perhaps because of the progressive
decline in left ventricular systolic function that was observed in those
with giant cell myocarditis.
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Giant cell versus lymphocytic myocarditis. A comparison of their clinical features and long-term outcomes
Evans Memorial Department of Clinical Research, Boston University Medical Center, Mass.
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