title: Ventricular remodeling in active myocarditis. Myocarditis Treatment Trial.
abstract: 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.
authors.affiliation: Evans Memorial Department of Clinical Research, Boston Medical Center, Boston, MA, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Mendes
authors.forename: M H
authors.initials: MH
authors.lastname: Picard
authors.forename: G W
authors.initials: GW
authors.lastname: Dec
authors.forename: V L
authors.initials: VL
authors.lastname: Hartz
authors.forename: I F
authors.initials: IF
authors.lastname: Palacios
authors.forename: R
authors.initials: R
authors.lastname: Davidoff
mesh_terms: 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
chemical_list: D007166:Immunosuppressive Agents