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(Circulation. 2003;107:e9010.)
© 2003 American Heart Association, Inc.

Cardiovascular News

Ruth SoRelle, MPH

Circulation Newswriter

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Immunosuppression in Myocarditis

Immunosuppression in patients with active lymphocytic myocarditis is most likely to be beneficial when there are circulating cardiac autoantibodies and no viral genome in the myocardium, according to Italian researchers in this week’s issue of Circulation (Circulation. 2003;107:857–863).

In this study led by Andrea Frustaci, MD, from the Department of Cardiology at Catholic University in Rome, Italy, 41 of 112 patients with a histological diagnosis of active lymphocytic myocarditis and lack of response to conventional therapy were treated with prednisone and azathioprine for 6 months. All underwent cardiac catheterization, angiography, and endomyocardial biopsy after 1 and 6 months of treatment. All were monitored for 1 year.

Of 41 patients, 21 had prompt improvement in left ventricular ejection fraction and showed evidence of healed myocarditis when they underwent biopsy. However, the other 20 patients did not respond. Twelve remained the same, 3 underwent heart transplantation, and 5 died.

Polymerase chain reaction of frozen endomyocardial tissue showed viral genomes present in 17 nonresponders. Among the viruses found were enterovirus, Epstein-Barr virus, adenovirus, influenza A virus, and parvovirus-B19. Viral genomes were also identified in 3 responders—all of them hepatitis C. Cardiac autoantibodies were present in 19 of the responders and in none of those who did not respond.

ACE Inhibitors in the Elderly
Treating older patients with high-blood pressure angiotensin converting enzyme (ACE) inhibitors resulted in better outcomes than treatment with diuretics, even though the blood pressures achieved were similar, according to Australian researchers in this week’s issue of the New England Journal of Medicine (. . . [Full Text of this Article]