title: Detailed pathologic evaluation on endomyocardial biopsy provides long-term prognostic information in patients with acute myocarditis.
abstract: BACKGROUND
  The long-term prognosis of biopsy-proven myocarditis is not well known. We hypothesized that a detailed pathological examination of an endomyocardial biopsy (EMB) would reveal prognostic information in patients with acute myocarditis.
  
  
  METHODS
  Fifty-four patients were diagnosed with acute myocarditis based on an EMB. Pathological diagnosis was categorized into lymphocytic dominant (29.6%), eosinophilic dominant (22.2%), and borderline myocarditis (48.1%). Masson's trichrome staining and further immunohistochemical staining for CD3, CD20, CD68, HLA-DR, TLR4, TLR8, enteroviral VP1, and caspase-3 expression were performed. The clinical outcomes were defined as all-cause and cardiovascular (CV) death.
  
  
  RESULTS
  During the median 10.4 years of follow up (9.7±5.7 years), the overall all-cause mortality was 20.4% and the CV mortality was 14.8% in patients with acute myocarditis. Lymphocytic dominant myocarditis patients showed a poor clinical outcome when compared with eosinophilic dominant myocarditis patients for both all-cause (37.5% vs. 0%, p=0.015) and CV (31.2% vs. 0%, p=0.029) mortality. Among borderline myocarditis patients, the presence of fibrosis was linked with poor clinical outcomes in both all-cause (75.0% vs. 21.4%, p=0.045) and CV (100.0% vs. 25.0%, p=0.034) mortality. No significant associations between clinical outcome and all other immunohistochemical staining targets were observed.
  
  
  CONCLUSIONS
  Detailed pathological evaluation on an EMB provides prognostic information in patients with acute myocarditis. EMB evaluation should be considered in patients with suspected myocarditis.
authors: Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Jong-Chan
authors: JC
authors: Youn
authors: Department of Pathology, Yonsei University College of Medicine, Seoul, Korea. Electronic address: shimhs@yuhs.ac.
authors: Hyo Sup
authors: HS
authors: Shim
authors: Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.
authors: Jae Seok
authors: JS
authors: Lee
authors: Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Ah-Young
authors: AY
authors: Ji
authors: Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Jaewon
authors: J
authors: Oh
authors: Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Namki
authors: N
authors: Hong
authors: Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea.
authors: Hye Sun
authors: HS
authors: Lee
authors: Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Sungha
authors: S
authors: Park
authors: Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Sang-Hak
authors: SH
authors: Lee
authors: Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Donghoon
authors: D
authors: Choi
authors: Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Namsik
authors: N
authors: Chung
authors: Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea; Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea. Electronic address: smkang@yuhs.ac.
authors: Seok-Min
authors: SM
authors: Kang
mesh_terms: D000208:Acute Disease; D000328:Adult; D001391:Azo Compounds; D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D004396:Coloring Agents; D004801:Eosine Yellowish-(YS); D004804:Eosinophils / Q000473:pathology; D005260:Female; D005355:Fibrosis; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008214:Lymphocytes / Q000473:pathology; D008297:Male; D008739:Methyl Green; D008875:Middle Aged; D009205:Myocarditis / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D009206:Myocardium / Q000737:chemistry / Q000473:pathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013194:Staining and Labeling / Q000379:methods; D013997:Time Factors; D055815:Young Adult
chemical_list: D001391:Azo Compounds; D015415:Biomarkers; D004396:Coloring Agents; C017768:trichrome stain; D008739:Methyl Green; D004801:Eosine Yellowish-(YS)
keywords: Diagnosis; Endomyocardial biopsy; Histopathology; Myocarditis; Prognosis