Usefulness of Immunosuppression for Giant Cell Myocarditis

Leslie T. Cooper, Joshua M. Hare, Henry D. Tazelaar, William D. Edwards, Randall C. Starling, Mario C. Deng, Santosh Menon, G. Martin Mullen, Brian Jaski, Kent R. Bailey, Madeleine W. Cunningham, G. William Dec

Research output: Contribution to journalArticle

Abstract

Giant cell myocarditis (GCM) is a rare and highly lethal disorder. The only multicenter case series with treatment data lacked cardiac function assessments and had a retrospective design. We conducted a prospective, multicenter study of immunosuppression including cyclosporine and steroids for acute, microscopically-confirmed GCM. From June 1999 to June 2005 in a standard protocol, 11 subjects received high dose steroids and cyclosporine, and 9 subjects received muromonab-CD3. In these, 7 of 11 were women, the mean age was 60 ± 15 years, and the mean time from symptom onset to presentation was 27 ± 33 days. During 1 year of treatment, 1 subject died of respiratory complications on day 178, and 2 subjects received heart transplantations on days 2 and 27, respectively. Serial endomyocardial biopsies revealed that after 4 weeks of treatment the degree of necrosis, cellular inflammation, and giant cells decreased (p = 0.001). One patient who completed the trial subsequently died of a fatal GCM recurrence after withdrawal of immunosuppression. Her case demonstrates for the first time that there is a risk of recurrent, sometimes fatal, GCM after cessation of immunosuppression. In conclusion, this prospective study of immunosuppression for GCM confirms retrospective case reports that such therapy improves long-term survival. Additionally, withdrawal of immunosuppression can be associated with fatal GCM recurrence.

Original languageEnglish (US)
Pages (from-to)1535-1539
Number of pages5
JournalThe American Journal of Cardiology
Volume102
Issue number11
DOIs
StatePublished - Dec 1 2008
Externally publishedYes

Fingerprint

Myocarditis
Giant Cells
Immunosuppression
Cyclosporine
Steroids
Prospective Studies
Muromonab-CD3
Recurrence
Heart Transplantation
Therapeutics
Multicenter Studies
Necrosis
Inflammation
Biopsy
Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cooper, L. T., Hare, J. M., Tazelaar, H. D., Edwards, W. D., Starling, R. C., Deng, M. C., ... Dec, G. W. (2008). Usefulness of Immunosuppression for Giant Cell Myocarditis. The American Journal of Cardiology, 102(11), 1535-1539. https://doi.org/10.1016/j.amjcard.2008.07.041

Usefulness of Immunosuppression for Giant Cell Myocarditis. / Cooper, Leslie T.; Hare, Joshua M.; Tazelaar, Henry D.; Edwards, William D.; Starling, Randall C.; Deng, Mario C.; Menon, Santosh; Mullen, G. Martin; Jaski, Brian; Bailey, Kent R.; Cunningham, Madeleine W.; Dec, G. William.

In: The American Journal of Cardiology, Vol. 102, No. 11, 01.12.2008, p. 1535-1539.

Research output: Contribution to journalArticle

Cooper, LT, Hare, JM, Tazelaar, HD, Edwards, WD, Starling, RC, Deng, MC, Menon, S, Mullen, GM, Jaski, B, Bailey, KR, Cunningham, MW & Dec, GW 2008, 'Usefulness of Immunosuppression for Giant Cell Myocarditis', The American Journal of Cardiology, vol. 102, no. 11, pp. 1535-1539. https://doi.org/10.1016/j.amjcard.2008.07.041
Cooper LT, Hare JM, Tazelaar HD, Edwards WD, Starling RC, Deng MC et al. Usefulness of Immunosuppression for Giant Cell Myocarditis. The American Journal of Cardiology. 2008 Dec 1;102(11):1535-1539. https://doi.org/10.1016/j.amjcard.2008.07.041
Cooper, Leslie T. ; Hare, Joshua M. ; Tazelaar, Henry D. ; Edwards, William D. ; Starling, Randall C. ; Deng, Mario C. ; Menon, Santosh ; Mullen, G. Martin ; Jaski, Brian ; Bailey, Kent R. ; Cunningham, Madeleine W. ; Dec, G. William. / Usefulness of Immunosuppression for Giant Cell Myocarditis. In: The American Journal of Cardiology. 2008 ; Vol. 102, No. 11. pp. 1535-1539.
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