TY - JOUR
T1 - Immunosuppressive Therapy Improves Both Short- and Long-Term Prognosis in Patients With Virus-Negative Nonfulminant Inflammatory Cardiomyopathy
AU - Merken, Jort
AU - Hazebroek, Mark
AU - Van Paassen, Pieter
AU - Verdonschot, Job
AU - Van Empel, Vanessa
AU - Knackstedt, Christian
AU - Hamid, Myrurgia Abdul
AU - Seiler, Michael
AU - Kolb, Julian
AU - Hoermann, Philipp
AU - Ensinger, Christian
AU - Brunner-La Rocca, Hans-Peter
AU - Poelzl, Gerhard
AU - Heymans, Stephane
PY - 2018/2/1
Y1 - 2018/2/1
N2 - BACKGROUND: Inflammatory cardiomyopathy (infl-CMP) is characterized by increased cardiac inflammation in the absence of viruses, ischemia, valvular disease, or other apparent causes. Studies addressing the efficacy of immunosuppressive therapy in patients with infl-CMP are sparse. This study retrospectively investigates whether immunosuppressive agents on top of heart failure therapy according to current guidelines improves cardiac function and long-term outcome in patients with infl-CMP. METHODS AND RESULTS: Within the Innsbruck and Maastricht Cardiomyopathy Registry, a total of 209 patients fulfilled the criteria for infl-CMP using endomyocardial biopsy (>= 14 infiltrating inflammatory cells/mm(2)). A total of 110 (53%) patients received immunosuppressive therapy and 99 (47%) did not. To correct for potential selection bias, 1: 1 propensity score matching was used on all significant baseline parameters, resulting in a total of 90 patients per group. Baseline characteristics did not significantly differ between both patient groups, reflecting optimal propensity score matching. After a median follow-up of 31 (15-47) months, immunosuppressive therapy resulted in an improved long-term outcome (eg, heart transplantation-free survival) as compared with standard heart failure therapy alone (Log-rank P=0.043; hazard ratio, 0.34 [95% CI, 0.17-0.92]) and in a significant larger increase of left ventricular ejection fraction after a mean of 12 months follow-up, as compared with patients receiving standard heart failure treatment only (12.2% versus 7.3%, respectively; P=0.036). CONCLUSIONS: To conclude, this study suggests that immunosuppressive therapy in infl-CMP patients results in an improved heart transplantation-free survival as compared with standard heart failure therapy alone, underscoring the urgent need for a large prospective multicenter trial.
AB - BACKGROUND: Inflammatory cardiomyopathy (infl-CMP) is characterized by increased cardiac inflammation in the absence of viruses, ischemia, valvular disease, or other apparent causes. Studies addressing the efficacy of immunosuppressive therapy in patients with infl-CMP are sparse. This study retrospectively investigates whether immunosuppressive agents on top of heart failure therapy according to current guidelines improves cardiac function and long-term outcome in patients with infl-CMP. METHODS AND RESULTS: Within the Innsbruck and Maastricht Cardiomyopathy Registry, a total of 209 patients fulfilled the criteria for infl-CMP using endomyocardial biopsy (>= 14 infiltrating inflammatory cells/mm(2)). A total of 110 (53%) patients received immunosuppressive therapy and 99 (47%) did not. To correct for potential selection bias, 1: 1 propensity score matching was used on all significant baseline parameters, resulting in a total of 90 patients per group. Baseline characteristics did not significantly differ between both patient groups, reflecting optimal propensity score matching. After a median follow-up of 31 (15-47) months, immunosuppressive therapy resulted in an improved long-term outcome (eg, heart transplantation-free survival) as compared with standard heart failure therapy alone (Log-rank P=0.043; hazard ratio, 0.34 [95% CI, 0.17-0.92]) and in a significant larger increase of left ventricular ejection fraction after a mean of 12 months follow-up, as compared with patients receiving standard heart failure treatment only (12.2% versus 7.3%, respectively; P=0.036). CONCLUSIONS: To conclude, this study suggests that immunosuppressive therapy in infl-CMP patients results in an improved heart transplantation-free survival as compared with standard heart failure therapy alone, underscoring the urgent need for a large prospective multicenter trial.
KW - heart failure
KW - immunosuppression
KW - inflammatory cardiomyopathy
KW - prognosis
KW - ANCA-ASSOCIATED VASCULITIS
KW - GIANT-CELL MYOCARDITIS
KW - DILATED CARDIOMYOPATHY
KW - ENDOMYOCARDIAL BIOPSY
KW - CONTROLLED-TRIAL
KW - HEART-FAILURE
KW - DIAGNOSIS
KW - AZATHIOPRINE
KW - MAINTENANCE
KW - PREDNISONE
U2 - 10.1161/CIRCHEARTFAILURE.117.004228
DO - 10.1161/CIRCHEARTFAILURE.117.004228
M3 - Article
C2 - 29449368
SN - 1941-3289
VL - 11
JO - Circulation-Heart Failure
JF - Circulation-Heart Failure
IS - 2
M1 - 004228
ER -