LONG-TERM OUTCOME OF PATIENTS WITH BIOPSY-PROVED MYOCARDITIS - COMPARISON WITH IDIOPATHIC DILATED CARDIOMYOPATHY
LONG-TERM OUTCOME OF PATIENTS WITH BIOPSY-PROVED MYOCARDITIS - COMPARISON WITH IDIOPATHIC DILATED CARDIOMYOPATHY
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DOI：
10.1016/0735-1097(95)00148-s
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发表时间：
1995-07-01
影响因子：
24
通讯作者：
RODEHEFFER, RJ
中科院分区：
文献类型：
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作者：
GROGAN, M;REDFIELD, MM;RODEHEFFER, RJ
目标.本研究的目的是1）评估活检证实的淋巴细胞性心肌炎（达拉斯标准）患者的长期预后; 2）比较这些患者与特发性扩张型心肌病患者的预后。扩张型心肌病患者常行肌内膜活检以鉴别淋巴细胞性心肌炎。大多数以前的研究心肌炎的自然史之前，达拉斯标准的建立。因此，使用淋巴细胞性心肌炎的标准化标准，评估扩张型心肌病患者内膜活检阳性结果的预后价值是很重要的。根据达拉斯标准对马约诊所（1979年10月至1988年4月）诊断为心肌炎的所有肌内膜活检结果进行重新分类。活检标本显示交界性或淋巴细胞性心肌炎的患者被纳入研究组;那些患有已知与心肌受累相关的全身炎症性疾病的患者被排除在外。将研究组的生存率与1976年至1987年在马约诊所就诊的特发性扩张型心肌病患者队列进行比较，这些患者的肌内膜活检结果为心肌炎阴性。41例患者的活检标本符合达拉斯诊断心肌炎（n = 28）或临界性心肌炎（n = 13）的标准。在这41例患者中，9例因存在已知与心肌炎相关的全身性疾病而被排除，5例因缺乏可用的随访数据而被排除。因此，心肌炎研究组包括27例患者（10例为临界性心肌炎，17例为心肌炎）。58例诊断为特发性扩张型心肌病并接受肌内膜活检的患者作为对照组。特发性扩张型心肌病患者的射血分数较低（[平均值+/- SD] 25 +/- 11%）（38 +/-19%，p = 0.001），尽管心肌炎组患者中纽约心脏协会功能分级III或IV级的比例（63%）高于扩张型心肌病组患者（30%，p = 0.005）。心肌炎组和特发性扩张型心肌病组的5年生存率无差异（分别为56%和54%）。这项研究表明，尽管与特发性扩张型心肌病患者的长期预后没有差异，但在转诊环境中观察到的活检证实的心肌炎患者的长期预后较差。由于目前缺乏有效的治疗淋巴细胞性心肌炎和心肌炎患者的生存益处的证据，这些数据表明，进行心肌内膜活检，以排除心肌炎是有限的预后价值在扩张型心肌病的常规评估。
Objectives. The study objectives were 1) to assess the long term outcome of patients with biopsy-proved lymphocytic myocarditis (Dallas criteria), and 2) to compare the outcome of these patients with that of patients,vith idiopathic dilated cardiomyopathy.Background. Endomyocardial biopsy is frequently performed in patients presenting with dilated cardiomyopathy to identify lymphocytic myocarditis. Most previous studies of the natural history of myocarditis were performed before the establishment of the Dallas criteria. Thus, it is important to evaluate the prognostic value of positive endomyocardial biopsy findings in patients presenting with dilated cardiomyopathy, using standardized criteria for lymphocytic myocarditis.Methods. All endomyocardial biopsy results from the Mayo Clinic (October 1979 to April 1988) with a diagnosis of myocarditis were reclassified according to the Dallas criteria. Patients whose biopsy specimens showed borderline or lymphocytic myocarditis were included in the study group; those with systemic inflammatory diseases known to be associated with myocardial involvement were excluded. Study group survival was compared with that for a cohort of patients with idiopathic dilated cardio myopathy seen at the Mayo Clinic from 1976 to 1987 who had endomyocardial biopsy findings negative for myocarditis.Results. Biopsy specimens from 41 patients met the Dallas criteria for a diagnosis of myocarditis (n = 28) or borderline myocarditis (n = 13). Of these 41 patients, 9 were excluded because of the presence of systemic diseases known to be associated with myocarditis, and 5 patients were excluded because of lack of available follow-up data. The myocarditis study group therefore included 27 patients (10 with borderline myocarditis, 17 with myocarditis). Fifty-eight patients with a diagnosis of idiopathic dilated cardiomyopathy who underwent endomyocardial biopsy served as the comparison cohort. Ejection fraction was lower in patients with idiopathic dilated cardiomyopathy ([mean +/- SD] 25 +/- 11%) than in those with myocarditis (38 +/- 19%, p = 0.001), even though a higher proportion of myocarditis group patients were in New York Heart Association functional class III or IV (63%) than patients in the dilated cardiomyopathy group (30%, p = 0.005). There was no difference in 5-year survival rate between the myocarditis and idiopathic dilated cardiomyopathy groups (56% vs. 54%, respectively).Conclusions. This study demonstrates that the long-term outcome of patients,vith biopsy-proved myocarditis seen in a referral setting is poor, although no different from that of patients with idiopathic dilated cardiomyopathy. With the current lack of proved effective treatment for lymphocytic myocarditis and no demonstration of survival benefit for patients with myocarditis, these data suggest that endomyocardial biopsy performed to exclude myocarditis is of limited prognostic value in the routine evaluation of dilated cardiomyopathy.