Ventricular remodeling in active myocarditis. Myocarditis Treatment Trial.
BACKGROUND
Remodeling of the left ventricle with the development of a spherical cavity occurs in dilated cardiomyopathy and is associated with a poor long-term prognosis. The early effects of myocarditis on left ventricular geometry have not been previously described or correlated with clinical outcome.


METHODS
The baseline echocardiograms of 35 patients with biopsy-confirmed myocarditis were compared with 20 normal controls. Left ventricular end-diastolic volume, long axis length, and mid-cavity diameter were measured. The degree of sphericity was expressed as the ratio of the mid-cavity diameter to the long axis length. Left ventricular ejection fraction was assessed by radionuclide angiography.


RESULTS
In patients with myocarditis, mean left ventricular volume of 81 +/- 29 mL/m(2) was significantly greater than 50 +/- 8 mL/m(2) in controls (P =.001). Chamber dilatation occurred primarily along the mid-cavity diameter, which measured 5.3 +/- 0.8 cm in patients with myocarditis versus 4.2 +/- 0.4 cm in controls (P =.001). The degree of left ventricular sphericity in patients with myocarditis, 0.64 +/- 0.08, was significantly greater than that of controls, 0.54 +/- 0.04 (P =.001). When patients were stratified according to left ventricular volume, patients with increased left ventricular volume (>75 mL/m(2)) were associated with a more spherical chamber and lower left ventricular ejection fraction than patients with a more normal left ventricular volume (</=75 mL/m(2)).


CONCLUSIONS
Active myocarditis is associated with early left ventricular remodeling and the development of a spherical chamber. These changes correlate with ventricular dilatation and reduced left ventricular ejection fraction.
Mendes
L A
LA
Evans Memorial Department of Clinical Research, Boston Medical Center, Boston, MA, USA.
Picard
M H
MH
Dec
G W
GW
Hartz
V L
VL
Palacios
I F
IF
Davidoff
R
R
D000328:Adult; D005260:Female; D006333:Heart Failure / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000503:physiopathology*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
D007166:Immunosuppressive Agents