Cited by 462Viral Infections and Immunology ResearchPericarditis and Cardiac TamponadeCardiac Fibrosis and Remodeling

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Immunosuppressive Therapy for Active Lymphocytic Myocarditis: Virological and Immunologic Profile of Responders Versus Nonresponders

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Frustaci, Andrea, Chimenti, Cristina, Calabrese, Fiorella, Pieroni, Maurizio, Thiene, Gaetano, Maseri, Attilio·2003·Circulation

DOI 10.1161/01.cir.0000048147.15962.31

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Abstract

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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Authors: Frustaci, A., Chimenti, C., Calabrese, F., Pieroni, M., Thiene, G., & Maseri, A.
Affiliations: University of Padua (IT)
ORCID: Frustaci, Andrea
Chimenti, Cristina
Calabrese, Fiorella
Pieroni, Maurizio
Thiene, Gaetano
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2003-02-18
Volume: 107
Issue: 6
Pages: 857-863
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/01.cir.0000048147.15962.31
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: green
www.openaccessrepository.it
Licence: other-oa
Locations: Circulation (publishedVersion)
PubMed (publishedVersion)
INFM-OAR (INFN Catania) (submittedVersion, other-oa)
Topics: Health Sciences › Medicine › Infectious Diseases › 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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Immunosuppressive Therapy for Active Lymphocytic Myocarditis: Virological and Immunologic Profile of Responders Versus Nonresponders

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