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Long-Term Risk of Recurrence, Morbidity and Mortality in Giant Cell Myocarditis

Giant cell myocarditis (GCM) is a rare disorder in which survival beyond 1 year without heart transplantation is uncommon. Long-term follow-up data on those with such survival are lacking. Twenty-six patients with biopsy-proved GCM who survived for > 1 year without heart transplantation were identified from a multicenter GCM registry. The incidence
of death, transplantation, ventricular assist device placement, and histologically proved disease recurrence was ascertained retrospectively. The rates of recurrent heart failure, ventricular arrhythmias, renal failure, and infectious complications were calculated. The mean age of the cohort was 54.6 ± 13.9 years (65% women). The mean follow-up duration was 5.5 years starting 1 year after diagnosis. There were 3 deaths (12%), 5
heart transplantations (19%), and 1 ventricular assist device placement (4%). Three histologically confirmed recurrences of GCM (12%) occurred between 1.5 and 8 years after diagnosis. Thirteen of 26 patients experienced a total of 30 heart failure episodes ≥1 year after initial diagnosis. There were 23 episodes of elevated creatinine in 12 patients, 41 infectious
events in 13 patients, and 19 episodes of ventricular arrhythmias in 6 patients with a total of 144 years of follow-up. Starting 1 year after GCM diagnosis, the combined rate of death, transplantation, ventricular assist device placement, and GCM recurrence was 47% at 5 years. In conclusion, the risk for GCM recurrence continues to ≥ 8 years after diagnosis.

Cardio-Oncology
Infective Endocarditis
Myocardial Disease
Pericardial Disease
Genomics
Cardiac Cellular Biology
Nutritional Heart Disease


Giant cell myocarditis (GCM) is a rare disorder in which survival beyond 1 year without heart transplantation is uncommon. Long-term follow-up data on those with such survival are lacking. Twenty-six patients with biopsy-proved GCM who survived for > 1 year without heart transplantation were identified from a multicenter GCM registry. The incidence
of death, transplantation, ventricular assist device placement, and histologically proved disease recurrence was ascertained retrospectively. The rates of recurrent heart failure, ventricular arrhythmias, renal failure, and infectious complications were calculated. The mean age of the cohort was 54.6 ± 13.9 years (65% women). The mean follow-up duration was 5.5 years starting 1 year after diagnosis. There were 3 deaths (12%), 5
heart transplantations (19%), and 1 ventricular assist device placement (4%). Three histologically confirmed recurrences of GCM (12%) occurred between 1.5 and 8 years after diagnosis. Thirteen of 26 patients experienced a total of 30 heart failure episodes ≥1 year after initial diagnosis. There were 23 episodes of elevated creatinine in 12 patients, 41 infectious
events in 13 patients, and 19 episodes of ventricular arrhythmias in 6 patients with a total of 144 years of follow-up. Starting 1 year after GCM diagnosis, the combined rate of death, transplantation, ventricular assist device placement, and GCM recurrence was 47% at 5 years. In conclusion, the risk for GCM recurrence continues to ≥ 8 years after diagnosis.

References


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Notes to editor


Joseph J. Maleszewski, MD a,b,*, Victor M. Orellana, MDc, David O. Hodge, MSd, Uwe Kuhl, MDe, Heinz-Peter Schultheiss, MDe, and Leslie T. Cooper, MDb
Divisions of aAnatomic Pathology and bCardiovascular Diseases and dDepartment of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; cDepartment of Medicine, Alpert Medical School, Brown University, Providence, Rhode Island; and eDepartment of Cardiology, Charite Hospital, Benjamin Franklin Campus, Berlin, Germany
Am J Cardiol. 2015 Mar 24. pii: S0002-9149(15)00978-9. doi: 10.1016/j.amjcard.2015.03.023.

Presented by Alida LP Caforio, MD, PhD, FESC, Cardiology, Dept of Cardiological Thoracic and Vascular Sciences, University of Padova, Italy. alida.caforio@unipd.it

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.