Key result
Advanced age in inflammatory cardiomyopathy is linked to ~89% more multiple viral genomes and hemodynamic compromise.
Cohort (n=695)
No
Elderly patients (≥ 70 years) with inflammatoric dilated cardiomyopathy present with more severe hemodynamic compromise, higher rates of multiple viral genomes, and a blunted immune response compared to younger patients.
May signal greater severity in elderly inflammatory cardiomyopathy; hypothesis-generating and requires prospective validation before guiding care.
BACKGROUND: Endomyocardial biopsy (EMB) is an important tool when patients with inflammatoric cardiomyopathy (DCMi) are evaluated. We aimed to assess the clinical profile of elderly patients with DCMi on EMB. METHODS: Retrospective study of all consecutive patients hospitalized from January 2007 to December 2011 with clinical suspicion of DCMi undergoing EMB. Patients with evidence of DCMi on EMB (Group 1 ≥ 70 years, n = 85; Group 3 < 70 years; n = 418) were compared to patients of the same age group without evidence of DCMi on EMB (Group 2 ≥ 70 years, n = 45; Group 4 < 70 years; n = 147). RESULTS: Among 24,275 patients treated at our institution during the study period, 695 had clinical suspicion of DCMi and underwent EMB; 503 (2.1%) patients had DCMi on EMB. There were more male patients in Group 1, mean age was 74 ± 2.8 years, mean ejection fraction was 38% ± 14%. On presentation, signs of hemodynamic compromise (NYHA functional class III/IV, low cardiac output/index, and low cardiac power index) were more frequent in Group 1. EMB revealed viral genome in 78% of the patients, parvovirus B19 (PVB) was frequently encountered in both age groups (Group 1: 69.4% vs. Group 2: 59.6%); detection of more than one viral genome was more frequent in Group 1 (21.2% vs. 11.2%; P = 0.02) whereas the extent of immune response was significantly lower in individuals with advanced age. CONCLUSIONS: In patients ≥ 70 years with DCMi on EMB signs of hemodynamic compromise, detection of multiple viral genomes together with an overall lower extent of immune response were more frequently observed.
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Ohlow et al. (2015) conducted a cohort in Inflammatoric dilated cardiomyopathy (DCMi) (n=695). Advanced age (≥ 70 years) vs. Age < 70 years was evaluated on Detection of more than one viral genome on endomyocardial biopsy (p=0.02). Elderly patients (≥ 70 years) with inflammatoric cardiomyopathy had a significantly higher rate of multiple viral genomes detected on biopsy (21.2% vs 11.2%) and more frequent hemodynamic compromise compared to younger patients.
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