Immunosuppressive therapy in inflammatory cardiomyopathy
Cardiology Department, Catholic University, Rome, Italy
* Correspondence: Andrea Frustaci, MD, Cardiology Department, Catholic University, Largo A. Gemelli 8, 00168 Rome, Italy.
Abstract
The role of immunosuppressive treatment in inflammatory cardiomyopathy is still controversial. Nevertheless, it is recommended in patients with eosinophilic myocarditis, granulomatous myocarditis, giant-cell myocarditis and lymphocytic myocarditis associated with connective tissue diseases or with rejection of a transplanted heart. There is growing evidence that some patients with idiopathic active myocarditis and cardiac dysfunction may benefit from immunosuppression. In the present review we define, through analysis of recent reports and the results of our own studies, the biological markers of candidates for immunosuppression.
Key Words: Autoantibodies immunosuppression inflammatory cardiomyopathy viruses
References
- Richardson P, McKenna W, Bristow M, et al. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of Cardiomyopathies. Circulation. 1996;93:841842
[Free Full Text] - Feldman AM, McNamara D. Myocarditis. N Engl J Med. 2000;343:13881398
[Free Full Text] - Chimenti C, Calabrese F, Thiene G, et al. Inflammatory left ventricular microaneurysms as a cause of apparently idiopathic ventricular tachyarrhythmias. Circulation. 2001;104:168173
[Abstract/Free Full Text] - Narula J, Khaw BA, Dec GW Jr., et al. Brief report: recognition of acute myocarditis masquerading as acute myocardial infarction. N Engl J Med. 1993;328:100104
[Free Full Text] - Angelini A, Calzolari V, Calabrese F, et al. Myocarditis mimicking acute myocardial infarction: role of endomyocardial biopsy in the differential diagnosis. Heart. 2000;84:245250
[Abstract/Free Full Text] - Frustaci A, Chimenti C, Maseri A. Global bi-ventricular dysfunction in patients with symptomatic coronary artery disease may be caused by myocarditis. Circulation. 1999;99:12951299
[Abstract/Free Full Text] - Mason JW, O'Connell JB, Herskowitz A, et al. A clinical trial of immunosuppressive therapy for myocarditis. N Engl J Med. 1995;333:269275
[Abstract/Free Full Text] - Aretz H, Billingham ME, Edwards WD, et al. Myocarditis. A histopatologic definition and classification. Am J Cardiovasc Pathol. 1986;1:314
- Kuhl U, Seeberg B, Schultheiss HP, et al. Immunohistological characterization of infiltrating lymphocytes in biopsies of patients with clinically suspected dilated cardiomyopathy. Eur Heart J. 1994;15:6267
- Pauschinger M, Bowles NE, Fuentes-Garcia FJ, et al. Detection of adenoviral genome in the myocardium of adult patients with idiopathic left ventricular dysfunction. Circulation. 1999;99:13481354
[Abstract/Free Full Text] - Pauschinger M, Doerner A, Kuehl U, et al. Enteroviral RNA replication in the myocardium of patients with left ventricular dysfunction and clinically suspected myocarditis. Circulation. 1999;99:889895
[Abstract/Free Full Text] - Noutsias M, Fechner H, de Jonge H, et al. Human coxsackie-adenovirus receptor is colocalized with integrins alpha(v)beta(3) and alpha(v)beta(5) on the cardiomyocyte sarcolemma and up-regulated in dilated cardiomyopathy: implications for cardiotropic viral infections. Circulation. 2001;104:275280
[Abstract/Free Full Text] - Badorff C, Lee GH, Lamphear BJ, et al. Enteroviral protease 2A cleaves dystrophin: evidence of cytoskeletal disruption in an acquired cardiomyopathy. Nat Med. 1999;5:320326[CrossRef][ISI][Medline]
- Chan KY, Iwahara A, Benson LN, et al. Immunosuppressive therapy in the management of acute myocarditis in children; a clinical trial. J Am Coll Cardiol. 1991;17:458460[Abstract]
- Matitiau A, Perez-Atayde A, Sanders SP, et al. Infantile dilated cardiomyopathy. Relation of outcome to left ventricular mechanics, hemodynamics, and histology at the time of presentation. Circulation. 1994;90:13101318
[Abstract/Free Full Text] - Lee KJ, McCrindle BW, Bohn DJ, et al. Clinical outcomes of acute myocarditis in childhood. Heart. 1999;82:226233
[Abstract/Free Full Text] - Kleinert S, Weintraub RG, Wilkinson JL, et al. Myocarditis in children with dilated cardiomyopathy: incidence and outcome after dual therapy immunosuppression. J Heart Lung Transplant. 1997;16:12481254[ISI][Medline]
- Parrillo JE, Cunnion RE, Epstein SE, et al. A prospective, randomized, controlled trial of prednisone for dilated cardiomyopathy. N Engl J Med. 1989;321:10611068[Abstract]
- Kuhl U, Schultheiss HP. Treatment of chronic myocarditis with corticosteroids. Eur Heart J. 1995;16(suppl O):168172
- Frustaci A, Gentiloni N, Chimenti C, et al. Necrotizing myocardial vasculitis in Churg-Strauss syndrome: clinicohistologic evaluation of steroids and immunosuppressive therapy. Chest. 1998;114:14841489
[Abstract/Free Full Text] - Badorff C, Schwimmbeck PL, Kuhl U, et al. Cardiac sarcoidosis: diagnostic validation by endomyocardial biopsy and therapy with corticosteroids. Z Kardiol. 1997;86:914[CrossRef]
- Cooper LT Jr., Berry GJ, Shabetai R. Idiopathic giant-cell myocarditis-natural history and treatment. Multicenter Giant Cell Myocarditis Study Group Investigators. N Engl J Med. 1997;336:18601866
[Abstract/Free Full Text] - Frustaci A, Chimenti C, Pieroni M, et al. Giant cell myocarditis responding to immunosuppressive therapy. Chest. 2000;117:905907
[Abstract/Free Full Text] - Frustaci A, Gentiloni N, Caldarulo M. Acute myocarditis and left ventricular aneurysm as presentations of systemic lupus erythematosus. Chest. 1996;109:282284
[Abstract/Free Full Text] - Billingham ME. Can histopathology guide immunosuppression for cardiac allograft rejection in the light of new techniques? Transplant Proc. 1997. p. 35S36S
- Dec GW Jr., Palacios IF, Fallon JT, et al. Active myocarditis in the spectrum of acute dilated cardiomyopathies. Clinical features, histologic correlates, and clinical outcome. N Engl J Med. 1985;312:885890[Abstract]
- Wojnicz R, Nowalany-Kozielska E, Wojciechowska C, et al. Randomized, placebo-controlled study for immunosuppressive treatment of inflammatory dilated cardiomyopathy: two-year follow-up results. Circulation. 2001;104:3945
[Abstract/Free Full Text] - Chimenti C, Pieroni M, Calabrese F, et al. Active lymphocytic myocarditis: virologic and immunologic profile of responders vs non-responders to immunosuppressive therapy. [abstract 2644]Circulation. 2001;104: (suppl)
- Kilbourne ED, Wilson CB, Perrier D. The induction of gross myocardial lesions by a coxsackie (pleurodynia) virus and cortisone. J Clin Invest. 1956;35:362370
- Kishimoto C, Thorp KA, Abelmann WH. Immunosuppression with high doses of cyclophoshamide reduces the severity of myocarditis but increases the mortality in murine coxsackievirus B3 myocarditis. Circulation. 1990;82:982989
[Abstract/Free Full Text] - Kuhl U, Pauschinger M, Schwimmbeck PL, et al. Interferon-ß treatment of patients with enteroviral and adenoviral cardiomyopathy causes effective virus clearance and long-term clinical improvement. [abstract]Circulation. 2001;104:3220 (suppl)
- Gutfreund KS, Bain VG. Chronic viral hepatitis C: management update. CMAJ. 2000;16:827833
- Martin AB, Webber S, Fricker FJ, et al. Acute myocarditis. Rapid diagnosis by PCR in children. Circulation. 1994;90:330339
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