What question did this study set out to answer?

To evaluate the histological response, functional recovery, and safety of immunosuppressive therapy combined with standard heart failure treatment in patients with dilated cardiomyopathy and biopsy-proven lymphocytic myocarditis.

September 1, 1989Cleveland Clinic Journal of Medicine

Lymphocytic myocarditis and dilated cardiomyopathy: treatment with immunosuppressive agents

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Why the study?

Does immunosuppressive therapy (prednisone and azathioprine) improve histologic and clinical outcomes in patients with congestive heart failure, dilated cardiomyopathy, and biopsy-proven lymphocytic myocarditis?

Key Points

To evaluate the histological response, functional recovery, and safety of immunosuppressive therapy combined with standard heart failure treatment in patients with dilated cardiomyopathy and biopsy-proven lymphocytic myocarditis.
Treated 34 patients (N=34) with congestive heart failure, dilated cardiomyopathy, and biopsy-proven lymphocytic myocarditis with prednisone and azathioprine for six months alongside standard heart failure therapy.
Evaluated histological changes via myocardial biopsy and monitored functional class, left ventricular dimensions, and ejection fraction.
Histological improvement or resolution of lymphocytic infiltrate occurred in 73% of patients, whereas 27% had persistent infiltrates; histological response correlated with improved left ventricular ejection fraction but not survival.
Serious or fatal adverse side effects directly resulting from immunosuppressive therapy occurred in 24% of patients.
Overall survival was 79% at one year and 76% at two years, with poor survival significantly associated with left ventricular ejection fraction under 20%, male sex, age under 50 years, and marked left ventricular dilation.

Structured PICO

Population

34 patients with history of congestive heart failure, dilated cardiomyopathy, and biopsy-proven lymphocytic myocarditis

Intervention

Prednisone and azathioprine for six months in addition to standard therapy for congestive heart failure

Outcome

Improvement or resolution of the lymphocytic infiltratesurrogate

Immunosuppressive therapy for lymphocytic myocarditis can improve histologic findings and left ventricular ejection fraction, but its use must be carefully weighed against a high risk of serious or fatal side effects.

Discussion

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Implication

May support immunosuppression for biopsy-proven lymphocytic myocarditis with LVEF gains; leaves open net benefit pending randomized trials given 24% serious events.

Cite This Study

Hobbs et al. (1989) studied this question.

synapsesocial.com/papers/6a922f728356c7bfaac800bb https://doi.org/10.3949/ccjm.56.6.628

Topics

Myocarditis

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Implication

May support immunosuppression for biopsy-proven lymphocytic myocarditis with LVEF gains; leaves open net benefit pending randomized trials given 24% serious events.

Lymphocytic myocarditis and dilated cardiomyopathy: treatment with immunosuppressive agents

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

Lymphocytic myocarditis and dilated cardiomyopathy: treatment with immunosuppressive agents

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

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