| Title | Usefulness of immunosuppression for giant cell myocarditis. | | Author(s) | Cooper LT, Hare JM, Tazelaar HD, Edwards WD, Starling RC, Deng MC, Menon S, Mullen GM, Jaski B, Bailey KR, Cunningham MW, Dec GW, Giant Cell Myocarditis Treatment Trial Investigators | | Institution | Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. cooper.leslie@mayo.edu | | Source | Am J Cardiol 2008 Dec 1; 102(11):1535-9. | | MeSH | Adult
Aged
Aged, 80 and over
Azathioprine
Cyclosporine
Female
Giant Cells
Humans
Immunosuppression
Immunosuppressive Agents
Male
Middle Aged
Muromonab-CD3
Myocarditis
Prospective Studies
Registries
Withholding Treatment
Young Adult
| | Abstract | Giant cell myocarditis (GCM) is a rare and highly lethal disorder. The only multicenter case series with treatment data lacked cardiac function assessments and had a retrospective design. We conducted a prospective, multicenter study of immunosuppression including cyclosporine and steroids for acute, microscopically-confirmed GCM. From June 1999 to June 2005 in a standard protocol, 11 subjects received high dose steroids and cyclosporine, and 9 subjects received muromonab-CD3. In these, 7 of 11 were women, the mean age was 60 +/- 15 years, and the mean time from symptom onset to presentation was 27 +/- 33 days. During 1 year of treatment, 1 subject died of respiratory complications on day 178, and 2 subjects received heart transplantations on days 2 and 27, respectively. Serial endomyocardial biopsies revealed that after 4 weeks of treatment the degree of necrosis, cellular inflammation, and giant cells decreased (p = 0.001). One patient who completed the trial subsequently died of a fatal GCM recurrence after withdrawal of immunosuppression. Her case demonstrates for the first time that there is a risk of recurrent, sometimes fatal, GCM after cessation of immunosuppression. In conclusion, this prospective study of immunosuppression for GCM confirms retrospective case reports that such therapy improves long-term survival. Additionally, withdrawal of immunosuppression can be associated with fatal GCM recurrence. | | Language | eng | | Pub Type(s) | Clinical Trial
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
| | PubMed ID | 19026310 |
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