Cardiomyopathy and Myocarditis
- Notes from European Society of Cardiology Congress, 2008
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Myocarditis- Virus Negative Inflammatory
Cardiomyopathy- ESC 2008
Reviewed the background for this prospective study.
Inclusion criteria were
- lymphocytic myocarditis
- Reduced EF below 45% for more than 6 months despite appropriate
pharmacological therapy
- negative PCR for virus- listed large number of viruses that were
screened out
Randomisation
- Group I- prednisone high dose 1mg/kg for four weeks and then
0.33mg/kg for ?weeks PLUS azothioprine
- Group II- placebo
Results at 6 months- echo
- in Grp I 88% of patients showed improvement with mean LVEDD
falling from 68mm to 52mm and mean EF improving from 28% to 48%. Even
patients with extremely severe dilation showed improvement- presented
two cases where the LVEDD was 85-90mm and where there was marked
improvement with marked reduction of size of LV with improvement of EF.
- in Grp II there was progressive deterioration, the mean LVEDD
increased from 69mm to 76mm, and the mean EF fell from 27% to 19%. 83%
showed deterioration, only seven patients remained stable in this group.
Results at 6 months- EMB
- presented data showed EMB improvement paralleled the clinical
change in Grp I patients.
Discussant
Refered to Mestroni et al in BMJ reviewing the pathogenesis of the
condition. Refered to data that indicates that immunosuppressin is
potentially harmful in those with viral persistence. This is the first
randomised trial of proven chronic myocardial inflammation without
evidence for viral persistence.
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