Survival in biopsy-proven myocarditis: A long-term retrospective analysis of the histopathologic, clinical, and hemodynamic predictors

We hypothesized that histopathology predicts survival without cardiac transplantation in patients with biopsy-proven myocarditis. The role of endomyocardial biopsy in diagnosing myocarditis remains controversial. Histopathology has been integrated with clinical and hemodynamic features to predict pr...

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Bibliographic Details
Published in:The American heart journal 2006-02, Vol.151 (2), p.463-470
Main Authors: Magnani, Jared W., Suk Danik, H. Jacqueline, Dec, G. William, DiSalvo, Thomas G.
Format: Article
Language:English
Subjects:
Age
Analysis of Variance
Biological and medical sciences
Biopsy
Cardiology. Vascular system
Endocardium - pathology
Female
Follow-Up Studies
Heart
Heart failure
Heart rate
Heart Transplantation
Histopathology
Humans
Ischemia
Male
Medical prognosis
Medical sciences
Middle Aged
Mortality
Multivariate analysis
Myocarditis - mortality
Myocarditis - pathology
Myocarditis - therapy
Myocarditis. Cardiomyopathies
Retrospective Studies
Studies
Survival Analysis
Variables
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Summary:We hypothesized that histopathology predicts survival without cardiac transplantation in patients with biopsy-proven myocarditis. The role of endomyocardial biopsy in diagnosing myocarditis remains controversial. Histopathology has been integrated with clinical and hemodynamic features to predict prognosis. However, the influence of histopathology on survival >5 years has not been explored. We retrospectively identified 112 consecutive patients with histopathologic confirmation of myocarditis. We examined these patients' clinical presentation, hemodynamic assessment, hospital course, and treatment. We selected 14 variables that might influence survival without cardiac transplantation. A total of 62 (55%) of 112 patients had lymphocytic myocarditis; 88 (79%) and 63 (56%) were alive without cardiac transplantation at 1 and 5 years, respectively. Median follow-up was a mean 95.5 months and median 74.5 months. Among the 55 with complete data of the 14 candidate predictor variables, age, sex, and clinical presentation with congestive heart failure and ventricular (ventricular tachycardia or fibrillation) or atrial arrhythmias (atrial fibrillation or flutter) did not predict the study end point of death or need for transplantation. In univariate analysis, pulmonary capillary wedge pressure ≥15 mm Hg significantly predicted the study end point. In multivariate analysis, pulmonary capillary wedge pressure ≥15 mm Hg and histopathology of lymphocytic, granulomatous, or giant cell myocarditis each significantly predicted mortality or transplant ( P = .047, P = .013, and P = .054, respectively) on cumulative survival without cardiac transplantation. Histopathology predicts long-term survival in patients with myocarditis. Clinical presentation, including presentation with congestive heart failure, ventricular tachycardia/ventricular fibrillation, or atrial fibrillation/atrial flutter, does not predict survival without transplantation. Endomyocardial biopsy can play a role in predicting transplant-free survival in patients with myocarditis.
ISSN:0002-8703
1097-6744
DOI:10.1016/j.ahj.2005.03.037