Detailed pathologic evaluation on endomyocardial biopsy provides long-term prognostic information in patients with acute myocarditis

• Published in: Cardiovascular pathology 2014-05, Vol.23 (3), p.139-144
• Main Authors: Youn, Jong-Chan, Shim, Hyo Sup, Lee, Jae Seok, Ji, Ah-Young, Oh, Jaewon, Hong, Namki, Lee, Hye Sun, Park, Sungha, Lee, Sang-Hak, Choi, Donghoon, Chung, Namsik, Kang, Seok-Min
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Azo Compounds; Biomarkers - analysis; Biopsy; Coloring Agents; Diagnosis; Endomyocardial biopsy; Eosine Yellowish-(YS); Eosinophils - pathology; Female; Fibrosis; Histopathology; Humans; Immunohistochemistry; Kaplan-Meier Estimate; Lymphocytes - pathology; Male; Methyl Green; Middle Aged; Myocarditis; Myocarditis - metabolism; Myocarditis - mortality; Myocarditis - pathology; Myocardium - chemistry; Myocardium - pathology; Pathology; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Factors; Staining and Labeling - methods; Time Factors; Young Adult
• ISSN: 1054-8807; 1879-1336
• DOI: 10.1016/j.carpath.2014.01.004

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.