Myocardial biopsy based classification and treatment in patients with dilated cardiomyopathy.
BACKGROUND
We investigated whether myocardial biopsy analysis for inflammation and viruses correlates with outcome in dilated cardiomyopathy.


METHODS
Myocardial biopsies of 82 patients were analyzed for HLAI, HLAII, CD54, CD2, CD68 and entero-/adenovirus. Ejection fraction was determined by left ventriculography. NYHA classification, electrocardiogram (ECG) and echocardiography were analyzed at first admission and for follow up. Patients were attributed to three groups: (A) no inflammation/no virus (B) inflammation/no virus (C) virus with/without inflammation. Patients not responding to conventional treatment of heart failure received interferon beta1b (group C) or prednisolone (group B). Median follow up was 7 months (group A), 11 months (group B) and 14.5 months (group C).


RESULTS
Thirty nine patients (48%) belonged to group A, 33 patients (40%) to group B, 10 patients (12%) to group C. Only enterovirus was detected. Ejection fraction at admission was worse for group B compared to group A (p=0.003). Groups A and B improved for echocardiography and NYHA (p< or =0.001). Group C improved for echocardiography only (p=0.031). Group B showed a better outcome for echocardiography (p=0.014) and NYHA (p=0.023) than group A.


CONCLUSIONS
Inflammatory cardiomyopathy shows the best outcome. Antiinflammatory or antiviral treatment may be an option in patients not responding to conventional therapy.
Zimmermann
Oliver
O
Department of Internal Medicine II-Cardiology, University of Ulm, Robert-Koch-Str. 8, 89081 Ulm, Germany. oliver.zimmermann@medizin.uni-ulm.de
Kochs
Matthias
M
Zwaka
Thomas Paul
TP
Kaya
Ziya
Z
Lepper
Philipp Moritz
PM
Bienek-Ziolkowski
Magdalena
M
Hoher
Martin
M
Hombach
Vinzenz
V
Torzewski
Jan
J
D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001706:Biopsy; D018801:CD2 Antigens / Q000187:drug effects / Q000378:metabolism; D002311:Cardiomyopathy, Dilated / Q000378:metabolism / Q000473:pathology* / Q000628:therapy*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006333:Heart Failure / Q000473:pathology / Q000628:therapy; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism; D000068576:Interferon beta-1b; D016899:Interferon-beta / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000473:pathology / Q000628:therapy; D009206:Myocardium / Q000473:pathology*; D011239:Prednisolone / Q000627:therapeutic use; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000187:drug effects
D000276:Adjuvants, Immunologic; D000893:Anti-Inflammatory Agents; D018801:CD2 Antigens; D018836:Inflammation Mediators; D000068576:Interferon beta-1b; D016899:Interferon-beta; D011239:Prednisolone