Key result
Immunosuppression started prior to mechanical circulatory support was associated with better survival than mechanical circulatory support alone.
Why the study?
The roles of mechanical circulatory support and immunotherapy are not well-defined in giant cell myocarditis.
Does initiating immunosuppression before mechanical circulatory support improve survival in patients with giant cell myocarditis?
Systematic Review (n=43)
Does initiating immunosuppression before mechanical circulatory support improve survival in patients with giant cell myocarditis?
In patients with giant cell myocarditis requiring mechanical circulatory support, initiating immunosuppression prior to MCS is associated with significantly better survival compared to MCS alone.
Answers are grounded in this paper and cite their sources.
May warrant pre-MCS immunosuppression consideration in giant cell myocarditis; extends observational data but leaves open need for RCTs.
Treatment of giant cell myocarditis (GCM) can require bridging to orthotopic heart transplantation (OHT) or recovery with mechanical circulatory support (MCS). Since the roles of MCS and immunotherapy are not well-defined in GCM, we sought to analyze outcomes of patients with GCM who required MCS. A systematic search was performed in June 2019 to identify all studies of biopsy-proven GCM requiring MCS after 2009. We identified 27 studies with 43 patients. Patient-level data were extracted for analysis. Median patient age was 45 (interquartile range (IQR): 32–57) years. 42.1% (16/38) were female. 34.9% (15/43) presented in acute heart failure. 20.9% (9/43) presented in cardiogenic shock. Biventricular (BiVAD) MCS was required in 76.7% (33/43) of cases. Of the 62.8% (27/43) of patients who received immunotherapy, 81.5% (22/27) used steroids combined with at least one other immunosuppressant. Cyclosporine was the most common non-steroidal agent, used in 40.7% (11/27) of regimens. Immunosuppression was initiated before MCS in 59.3% (16/27) of cases, after MCS in 29.6% (8/27), and not specified in 11.1% (3/27). Immunosuppression started prior to MCS was associated with significantly better survival than MCS alone (p = 0.006); 60.5% (26/43) of patients received bridge-to-transplant MCS; 39.5% (17/43) received bridge-to-recovery MCS; 58.5% (24/41) underwent OHT a median of 104 (58–255) days from diagnosis. GCM recurrence after OHT was reported in 8.3% (2/24) of transplanted cases. BiVAD predominates in mechanically supported patients with GCM. Survival and bridge to recovery appear better in patients on immunosuppression, especially if initiated before MCS.
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Patel et al. (2020) conducted a systematic review in Giant cell myocarditis requiring mechanical circulatory support (n=43). Immunosuppression initiated before mechanical circulatory support vs. Mechanical circulatory support alone was evaluated on Survival (p=0.006). Immunosuppression started prior to mechanical circulatory support was associated with better survival than mechanical circulatory support alone.
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