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July 1, 2020Työväentutkimus VuosikirjaOpen Access

Long-Term Outcome and its Predictors in Giant Cell Myocarditis. Letter Regarding the Article ‘Long-Term Outcome and its Predictors in Giant Cell Myocarditis’

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Key result

Giant cell myocarditis predicts ~168% greater risk of death or transplantation versus cardiac sarcoidosis.

  • HR 2.68
  • 95% CI 1.22-5.87
  • P=0.014
  • n=46

Why the study?

Incidental cases of giant cell myocarditis converted to cardiac sarcoidosis at post-transplant or post-mortem examinations prompted a re-evaluation of national giant cell myocarditis diagnoses.

Population

46 patients diagnosed with GCM since 1991 in Finland

Comparison

Patients reclassified as CS vs patients keeping GCM diagnosis

Design

Re-evaluation of a previously reported cohort

Follow-up

5 years

Authors

KEKaj EkströmARAnne Räisänen‐SokolowskiJLJukka Lehtonen

Discussion

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Overview

Confirmed giant cell myocarditis signals high death or transplant risk; leaves open refined incidence and outcomes after sarcoidosis reclassification.

Structured PICO

P
Population
46 patients originally diagnosed with giant cell myocarditis in Finland since 1991, re-evaluated to distinguish true GCM from cardiac sarcoidosis.
C
Comparator
Cardiac sarcoidosis (CS)
O
Outcome
Transplant-free survival (occurrence of death or transplantation)hard clinical

Main Result

Hazard Ratio: 2.68 (95% CI 1.22–5.87)

p-value: p=0.014

Re-evaluation of a historical giant cell myocarditis cohort revealed that over half of the cases were actually cardiac sarcoidosis, and true giant cell myocarditis has a significantly worse 5-year transplant-free survival (25%) than previously estimated.

Limitations

  • Differentiation of cardiac sarcoidosis and giant cell myocarditis on microscopy of tiny endomyocardial samples can be very difficult.
  • Researchers divide on the diagnostic role of myocardial granulomas.
  • Cardiac sarcoidosis and giant cell myocarditis may be intimately related diseases or partially overlapping segments of a single disease spectrum.
  • Differentiation of cardiac sarcoidosis and giant cell myocarditis on microscopy of tiny endomyocardial samples can be very difficult
  • Researchers divide on the diagnostic role of myocardial granulomas

Cite This Study

Ekström et al. (2020) conducted a letter in Giant cell myocarditis and cardiac sarcoidosis (n=46). Giant cell myocarditis vs. Cardiac sarcoidosis was evaluated on Death or transplantation (HR 2.68, 95% CI 1.22-5.87, p=0.014). A confirmed diagnosis of giant cell myocarditis predicted the occurrence of death or transplantation with a hazard ratio of 2.68 (95% CI 1.22-5.87; P=0.014).

synapsesocial.com/papers/6a9c69a1a2aa65bfe0978efehttps://doi.org/10.1002/ejhf.1953
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Manifestations and Outcome of Cardiac Sarcoidosis and Idiopathic Giant Cell Myocarditis by 25‐Year Nationwide Cohorts2021 · 61 citations
  2. 2Diagnosis, management, and outcome of cardiac sarcoidosis and giant cell myocarditis: a Swedish single center experience2022 · 29 citations
  3. 3Idiopathic Giant Cell Myocarditis or Cardiac Sarcoidosis? A Retrospective Audit of a Nationwide Case Series2020 · 34 citations
  4. 4Long-Term Outcome and its Predictors in Giant Cell Myocarditis2016 · 91 citations
  5. 5Phenotyping of giant cell myocarditis versus cardiac sarcoidosis using cardiovascular magnetic resonance2023 · 15 citations