Abstract 15036: Resolution Of Inflammation Determines Short- And Longterm Prognosis In Myocarditis - data From Esetcid
Treatment of inflammatory dilated Cardiomyopathy (iDCM) beyond heart failure treatment is a matter of controversy. The TIMIC study demonstrated hemodynamic and clinical benefit in acute myocarditis patients with a negative viral PCR in the biopsy. In the European Study of Epidemiology and Treatment of Inflammatory Heart Disease (ESETCID) patients with chronic autoreactive (virus negative) myocarditis and a reduced ejection fraction (EF<45%) were randomised for double blind treatment with azathioprin and prednisolone vs. placebo.
Methods: Endomyocardial biopsies were examined for infiltrating cells imunhistochemically according to the WHF- and the Dallas-Criteria. The presence of viral genome was assessed by quantitative PCR to exclude those patients from immunosuppressive treatment (IT). 101 patients (mean age 48±10 years, 79 male, 22 female) with inflammatory heart disease were randomised. The Verum Group (n=54) started with azathioprin 2mg/kg BW/day and prednisolone 1.25mg/kg BW/ for 4 weeks, the maintenance dose for the residual 5 months was 0.85mg/kg BW/day rsp. 0.3mg/kg B/day for 5 month.
Results: Resolution of inflammation was significantly better in the verum(IT) group with 63%(p<0.05) when compared to spontaneous resolution in 45% of pts in the placebo(P) group after 6 months. Mean ejection fraction(EF) improved significantly only in patients in whom inflammation had resolved either by IT (verum) or spontaneously(P) when compared to baseline values. Improvement of hemodynamics was paralleled by a reduction of NYHA severity in the pts who did not demonstrate infiltrates at the follow-up biopsy. Recurrence of severe heart failure with hospitalisation, death or heart transplantation was observed in the longterm follow-up of 5 years was seen more often in patients with residual inflammation (p<0.01).
Conclusion: The resolution of the infiltrate determines short- and longterm prognosis in patients with myocarditis.
- © 2011 by American Heart Association, Inc.