Immunosuppressive Therapy for Active Lymphocytic Myocarditis: Virological and Immunologic Profile of Responders Versus Nonresponders
Open accessAbstract
Background— The beneficial effect of immunosuppressive treatment on myocarditis is still controversial, possibly because the immunologic and virological profile of potential candidates is largely unknown. Methods and Results— Out of 652 biopsied patients, 112 had a histological diagnosis of active lymphocytic myocarditis; 41 of these 112 patients were characterized by progressive heart failure despite conventional therapy and were treated with prednisone and azathioprine for 6 months. All were resubmitted to cardiac catheterization, angiography, and endomyocardial biopsy at 1 and 6 months and followed-up for 1 year. A total of 21 patients responded with prompt improvement in left ventricular ejection fraction from 25.7±4.1% to 47.1±4.4% and showed evidence of healed myocarditis at control biopsy. Conversely, 20 patients failed to respond and showed a histological evolution toward dilated cardiomyopathy: 12 remained stationary, 3 underwent cardiac transplantation, and 5 died. We retrospectively performed a polymerase chain reaction on frozen endomyocardial tissue for the most common cardiotropic viruses and assessed circulating serum cardiac autoantibodies. Viral genomes were present in biopsy specimens of 17 nonresponders (85%), including enterovirus (n=5), Epstein-Barr virus (n=5) adenovirus (n=4), both adenovirus and enterovirus (n=1), influenza A virus (n=1), parvovirus-B19 (n=1), and in 3 responders, who were all positive for hepatitis C virus. Cardiac autoantibodies were present in 19 responders (90%) and in none of the nonresponders. Conclusions— In patients with active lymphocytic myocarditis, those with circulating cardiac autoantibodies and no viral genome in the myocardium are the most likely to benefit from immunosuppression. The beneficial effect of immunosuppression in hepatitis C virus myocarditis suggests a relevant immunomediated component of damage.
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Virus-negative lymphocytic myocarditis may have alternative pathogenesis such as autoimmunity, hypersensitivity, or medication usage.
“suggesting potential alternative pathogenesis such as autoimmunity, hypersensitivity, or medication usage.”
From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [152]
The Discussion (page not specified in our copy) suggests that some lymphocytic myocarditis may be elicited by autoimmune disease, and its conclusion links the absence of viral genome with cardiac autoantibodies. It does not identify hypersensitivity or medication use as alternative causes. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn some cases of lymphocytic myocarditis, viruses test negative while heart-specific autoantibodies are present.
“Notably, in some cases of lymphocytic myocarditis, these viruses tested negative, while autoantibodies specific to the heart were present”
From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [152]
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- Authors
- Frustaci, A., Chimenti, C., Calabrese, F., Pieroni, M., Thiene, G., & Maseri, A.
- Affiliations
- University of Padua (IT)
- Venue
- Circulation
- Published
- 2003-02-18
- Volume
- 107
- Issue
- 6
- Pages
- 857-863
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W1968165176
- Cited by
- 462
- References
- 23
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 15 · 2023: 11 · 2022: 14 · 2021: 11 · 2020: 17 · 2019: 17 · 2018: 10 · 2017: 21 · 2016: 15 · 2015: 11 · 2014: 20 · 2013: 27 · 2012: 23
- FWCI
- 21.60
- Type
- journal article
- Language
- en
- Open access
- Licence
- other-oa
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- INFM-OAR (INFN Catania) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Viral Infections and Immunology Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Pericarditis and Cardiac Tamponade
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Fibrosis and Remodeling
- Keywords
- lymphocytic myocarditis, immunosuppressive therapy, prednisone, azathioprine, heart failure, cardiac autoantibodies, viral myocarditis, endomyocardial biopsy, dilated cardiomyopathy, treatment response
- MeSH terms
- Adolescent, Adult, Autoantibodies, Azathioprine, Biopsy, Cardiotonic Agents, Chronic Disease, Echocardiography, Female, Follow-Up Studies, Heart, Heart Failure, Hemodynamics, Humans, Immunosuppressive Agents, Lymphocytes, Male, Middle Aged, Myocarditis, Myocardium, Prednisone, Retrospective Studies, Severity of Illness Index, Stroke Volume, Treatment Outcome
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