Apoptosis in patients with acute myocarditis.
Acute myocarditis is an acute inflammatory syndrome characterized by acute myocardial damage and dysfunction followed by a variable recovery over time with some patients progressing toward severe dilated cardiomyopathy. Cardiomyocyte apoptosis, a key pathologic feature of heart failure, may play a critical role in functional recovery in patients with acute myocarditis. The aim of the study was to investigate whether apoptosis predicts functional recovery in patients with acute myocarditis. Sixteen patients with biopsy-documented acute myocarditis were followed for 1 year with serial transthoracic echocardiography. Functional recovery was defined as 12-month left ventricular ejection fraction >40%. Cardiomyocyte apoptosis, leukocyte infiltration, and cell proliferation was assessed in all samples. A group of cases in which the diagnosis of acute myocarditis was made after death was also selected for comparison, and morphologically normal hearts from patients who died from a noncardiac cause were selected as controls. Six patients (38%) had functional recovery at 12 months, whereas 10 (62%) did not. The 2 groups had similar characteristics except for lower baseline left ventricular ejection fraction in the group with functional recovery. Apoptotic rate was found to be significantly higher in patients with acute myocarditis than in control hearts, and, unexpectedly, patients with functional recovery had significantly higher apoptotic rates than patients without recovery (3.2% vs 0.5%, p = 0.001). None of the patients with apoptotic rates below the median had functional recovery versus 86% of patients with apoptotic rates above the median (p <0.001). In conclusion, higher rates of cardiomyocyte apoptosis in patients with acute myocarditis are associated with functional recovery at 1 year.
Abbate
Antonio
A
VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA. aabbate@mcvh-vcu.edu
Sinagra
Gianfranco
G
Bussani
Rossana
R
Hoke
Nicholas N
NN
Merlo
Marco
M
Varma
Amit
A
Toldo
Stefano
S
Salloum
Fadi N
FN
Biondi-Zoccai
Giuseppe G L
GG
Vetrovec
George W
GW
Crea
Filippo
F
Silvestri
Furio
F
Baldi
Alfonso
A
D000208:Acute Disease; D000328:Adult; D017209:Apoptosis; D015415:Biomarkers / Q000032:analysis; D001707:Biopsy, Needle; D004452:Echocardiography; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D020287:In Situ Nick-End Labeling; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D009205:Myocarditis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology; D032383:Myocytes, Cardiac / Q000473:pathology*; D011336:Probability; D011446:Prospective Studies; D020127:Recovery of Function; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate
D015415:Biomarkers