Abstract 14181: Poor Long-Term Prognosis in Patients With Inflammatory Dilated Cardiomyopathy Diagnosed by Immunohistochemistry-Based Criteria
Background: Dilated cardiomyopathy (DCM) is highly heterogeneous and the future clinical course is almost unpredictable due to its diversity in each individual patient. Inflammatory DCM (DCMi) is defined by World Heart Federation (WHF) criteria as 14/mm2 or more infiltrating T-lymphocytes or activated T-cells (including up to 4 macrophages) in the endomyocardial biopsy of a dilated heart. However, detail characteristics and long-term prognosis in patients with DCMi have not been fully understood.
Methods: One hundred and sixteen consecutive patients between 2005 and 2007, who were finally diagnosed as DCM after right ventricular endomyocardial biopsy, were studied. Stored biopsy samples were immunohistochemically stained with antibodies specific for CD3 (T-lymphocytes) and CD68 (macrophages) to count the number of infiltrating cells into myocardium. We also collected each patient’s clinical characteristics, as well as prognostic data up to 9 years (mean 6.7 years) from diagnosis.
Results: In total, 66 patients (57%) met the criteria for DCMi. Those patients showed no different baseline characteristics at diagnosis including age, sex, medications, past history, serum Na, creatinine, plasma BNP level, LV dimension, LV ejection fraction, and LV end-diastolic pressure compared to non-DCMi patients. During the observation period, 17 patients had poor clinical outcome of death or heart transplantation. Fifteen out of 66 patients with DCMi, despite only 2 out of 50 patients with non-DCMi, showed poor clinical outcome (23% vs 4%, p=0.007). Kaplan-Meier analysis revealed that DCMi patients had poorer long-term transplantation-free survival than non-DCMi patients (log-rank p=0.009, Figure).
Conclusions: In our study, 57% of DCM patients fulfilled the immunohistochemistry-based criteria for DCMi defined by WHF. Patients who met the DCMi criteria had remarkably poor long-term prognosis regardless of similar baseline characteristics at diagnosis.
Author Disclosures: Y. Sugano: None. T. Nakayama: None. T. Yokokawa: None. T. Nagai: None. K.O. Ogo: None. Y. Ikeda: None. H.I. Ueda: None. T. Nakatani: None. S. Yasuda: None. H. Ogawa: Other Research Support; Modest; Astellas Pharma Inc, Bristol-Myers Squibb Company, Chugai Pharmaceutical Co, Ltd., Dainippon Sumitomo Pharma Co., Ltd., MSD K.K., Mochida Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd., Otsuka, Pfizer Japan Inc, Takeda Pharmaceutical Co., Ltd.. Other Research Support; Significant; Bayer, Daiichi Sankyo Co., Ltd., Novartis Pharma K.K., Sanofi K.K.. Honoraria; Modest; AstraZeneca K.K., Boehringer Ingelheim Japan, Bristol-Myers Squibb Company, Mitsubishi Tanabe Pharma, Pfizer Japan Inc, Sanofi K.K., Teijin Pharma Co., Ltd. Honoraria; Significant; Bayer Yakuhin, Ltd., Daiichi Sankyo Co., Ltd., MSD K.K., Takeda Pharmaceutical Co., Ltd.. T. Anzai: None.
- © 2015 by American Heart Association, Inc.