title: Correlations of the changes in bioptic findings with echocardiographic, clinical and laboratory parameters in patients with inflammatory cardiomyopathy.
abstract: Patients with myocarditis and left ventricular (LV) dysfunction may improve after standard heart failure therapy. This improvement seems to be related to retreat of myocardial inflammation. The aim of the present study was to assess changes in clinical, echocardiographic and some laboratory parameters and to correlate them with changes in the number of inflammatory infiltrating cells in endomyocardial biopsy (EMB) samples during the 6-month follow-up, and to define predictors of LV function improvement among baseline parameters. Forty patients with biopsy-proven myocarditis and impaired LV function (LV ejection fraction-LVEF <40 %) with heart failure symptoms ≤ 6 months were evaluated. Myocarditis was defined as the presence of >14 mononuclear leukocytes/mm(2) and/or >7 T-lymphocytes/mm(2) in the baseline EMB. The EMB, echocardiography and clinical evaluation were repeated after 6 months of standard heart failure therapy. LVEF improved on average from 25 ± 9 to 42 ± 12 % (p < 0.001); LV end-systolic volume and LV end-diastolic volume (LVEDV) decreased from 158 ± 61 to 111 ± 58 ml and from 211 ± 69 to 178 ± 63 ml (both p < 0.001). NYHA class decreased from 2.6 ± 0.5 to 1.6 ± 0.6 (p < 0.001) and NTproBNP from 2892 ± 3227 to 851 ± 1835 µg/ml (p < 0.001). A decrease in the number of infiltrating leukocytes (CD45+/LCA+) from 23 ± 15 to 13 ± 8 cells/mm(2) and in the number of infiltrating T lymphocytes (CD3+) from 7 ± 5 to 4 ± 3 cells/mm(2) (both p < 0.001) was observed. The decline in the number of infiltrating CD45+ cells significantly correlated with the change in LVEF (R = -0.43; p = 0.006), LVEDV (R = 0.39; p = 0.012), NYHA classification (R = 0.35; p = 0.025), and NTproBNP (R = 0.33; p = 0.045). The decrease in the number of CD3+ cells correlated with the change of systolic and diastolic diameters of the left ventricle (R = -0.33; p = 0.038 and R = -0.45; p = 0.003) and with the change in LVEDV (R = -0.43; p = 0.006). Tricuspid annular plane systolic excursion (TAPSE) (OR 0.61; p = 0.005) and early transmitral diastolic flow velocity (E wave) (OR 0.89; p = 0.002) were identified as predictors of LVEF improvement. Improvements in clinical status, LV function and NTproBNP levels correlated with decrease in the number of infiltrating inflammatory cells. TAPSE and E wave velocity were significant predictors of improvement in multivariate regression. Our observations suggest that contemporary guidelines-based therapy of heart failure is an effective treatment option in patients with recent onset biopsy-proven inflammatory cardiomyopathy.
authors.affiliation: Department of Cardiovascular Diseases, St. Anne's University Hospital, International Clinical Research Center, Pekarska 53, 65690, Brno, Czech Republic. jan.krejci@fnusa.cz.|Masaryk University, Brno, Czech Republic. jan.krejci@fnusa.cz.
authors.forename: Jan
authors.initials: J
authors.lastname: Krejci
authors.affiliation: Department of Cardiovascular Diseases, St. Anne's University Hospital, International Clinical Research Center, Pekarska 53, 65690, Brno, Czech Republic.|Masaryk University, Brno, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Hude
authors.affiliation: Department of Cardiovascular Diseases, St. Anne's University Hospital, International Clinical Research Center, Pekarska 53, 65690, Brno, Czech Republic.|Masaryk University, Brno, Czech Republic.
authors.forename: Hana
authors.initials: H
authors.lastname: Poloczkova
authors.affiliation: Masaryk University, Brno, Czech Republic.|1st Department of Pathologic Anatomy, St. Anne's University Hospital, Brno, Czech Republic.
authors.forename: Vita
authors.initials: V
authors.lastname: Zampachova
authors.affiliation: International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.
authors.forename: Radka
authors.initials: R
authors.lastname: Stepanova
authors.affiliation: Centre for Cardiovascular Surgery and Transplantation, Brno, Czech Republic.
authors.forename: Tomas
authors.initials: T
authors.lastname: Freiberger
authors.affiliation: International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.|Centre for Cardiovascular Surgery and Transplantation, Brno, Czech Republic.
authors.forename: Eva
authors.initials: E
authors.lastname: Nemcova
authors.affiliation: Department of Cardiovascular Diseases, St. Anne's University Hospital, International Clinical Research Center, Pekarska 53, 65690, Brno, Czech Republic.|Masaryk University, Brno, Czech Republic.
authors.forename: Lenka
authors.initials: L
authors.lastname: Spinarova
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002634:Chemotaxis, Leukocyte; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009205:Myocarditis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D009206:Myocardium / Q000378:metabolism / Q000473:pathology*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D016017:Odds Ratio; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012307:Risk Factors; D013318:Stroke Volume / Q000187:drug effects; D013601:T-Lymphocytes / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D015415:Biomarkers; D002317:Cardiovascular Agents; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Echocardiography; Endomyocardial biopsy; Inflammatory cardiomyopathy; Left ventricular dysfunction; Myocarditis