Abstract 3586: Noninvasive Follow Up of Patients After Full Recovery from Chronic Myocarditis
The clinical features of inflammatory myocarditis (MC) vary widely, from an asymptomatic subclinical infection on the one extreme to a fulminant and fatal course with biventricular failure on the other. Typically the patient complain of dyspnea, fatique, precordial discomfort or palpitations from arrhythmias. Aim of the following study was to perform a noninvasive follow-up of patients (pts) after full recovery from MC.
Methods: The diagnosis of MC was definitively made from histologic and immunohistological (lymphocytic infiltration, enhanced expression of human class 1 and 2 antigens) examinations of heart muscle, obtained from a right ventricular endomyocardial biopsy. Chronic MC was confirmed by a 2nd sequential right ventricular endomyocardial biopsies after 3 months. Overall 34 pts were examined by dobutamine stress echocardiography 48± months after follow-up biopsies revealed negative histological and immunhistological results. The control group (C) consisted of 34 pts with excluded cardiac disease. In 27 pts therapy with prednisolone was started, 9 pts were treated only conservative (ACE inhibitors and diuretics). Beside clinical and morphological data hemodynamics were assessed by Doppler-echocardiography at rest and at maximum doses of dobutamine infusion: systolic fractional shortening; maximal early and late velocity of diastolic filling, E/A-ratio, deceleration time and isovolumetric relaxation time.
Results: 23 pts showed good exercise tolerance and no cardiac discomfort. However 11 pts described exercise dependent dyspnea (NYHA II). In all pts normal systolic and diastolic function at rest and normal systolic function at maximum doses of dobutamine infusion was documented. In the 11 pts with clinical signs of heart failure (9 pts with conservative therapy and 2 pts after immunosuppressive therapy) left ventricular diastolic dysfunction in terms of a delayed relaxation pattern was revealed by dobutamine stress echocardiography (at rest: pts with MC p=.s.; at stress: in pts with MC p<.01).
Conclusion: Immunsuppressive therapy in patients with chronic myocarditis may be superior to only conservative therapy concerning left ventricular diastolic function after full recovery.