Recently diagnosed idiopathic dilated cardiomyopathy: Incidence of myocarditis and efficacy of prednisone therapy

• Published in: The American heart journal Vol. 117; no. 4; pp. 876 - 882
• Main Authors: Latham, Ricky D., Mulrow, John P., Virmani, Renu, Robinowitz, Max, Moody, Joe M.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.04.1989; Elsevier
• Subjects: Adult; Biological and medical sciences; Cardiomyopathy, Dilated - complications; Cardiomyopathy, Dilated - drug therapy; Cardiomyopathy, Dilated - mortality; Cardiomyopathy, Dilated - pathology; Cardiovascular system; Female; Humans; Male; Medical sciences; Middle Aged; Miscellaneous; Myocarditis - complications; Myocarditis - pathology; Myocardium - pathology; Pharmacology. Drug treatments; Prednisone - therapeutic use; Therapeutic efficiency; Human; Myocarditis; Chemotherapy; Cardiomyopathy; Heart disease; Cardiovascular disease; Prednisone; Glucocorticoid; Survival
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/0002-8703(89)90626-1

Fifty-two patients with recently diagnosed idiopathic dilated cardiomyopathy were studied to determine the incidence of myocarditis; patients were randomly assigned to receive either conventional therapy alone or conventional therapy plus prednisone to assess possible therapeutic efficacy with regard to survival. Inflammatory criteria were present in 23% of the population studied with 13% having overt myocarditis according to the Dallas criteria. The addition of prednisone to conventional therapy did not improve survival in a homogeneous population with new-onset dilated cardiomyopathy. Furthermore, the diagnosis of myocarditis by endomyocardial biopsy did not influence 2-year survival once dilated cardiomyopathy had developed. Biopsy-documented myocarditis resolved in all patients, according to results of 3-month follow-up endomyocardial biopsies, regardless of treatment group. There was a trend for patients with a left ventricular ejection fraction less than 20% to show reduced survival at 2 years compared to the group with a higher ejection fraction ( p = 0.07). Right ventricular dysfunction determined at catheterization was present in 20 of 52 patients and was the most significant predictor of survival. Patients with precerved right ventricular function had a 95% 24-month survival rate compared to 47% for patients with right ventricular diastolic dysfunction (right ventricular end-diastolic pressure ≥11 mm Hg) ( p = 0.005).