[Is there a clinical value of endomyocardial biopsy and immunosuppressive treatment in idiopathic dilated cardiomyopathy? Study by meta analysis].

This study was intended to answer two questions: 1) whether the prognosis of patients with dilated cardiomyopathy and myocardial inflammatory changes, and 2) whether immunosuppressive agents may modify survival. The meta-analysis technique was employed as a tool in order to homogenize the results of several reports that were not conclusive and often contradictory due to the small number of patients studied. Twenty one reports were included; in 12, there was a follow up study of patients with acute inflammatory changes. Four reports compared the follow up of groups showing acute inflammatory changes with controls with dilated cardiomyopathy lacking inflammatory phenomena in the biopsy, including a total of 272 patients; 47 (17.3%) disclosed inflammatory changes. Total mortality for this group was 25.6% while that for the control group was 28.4% (p = NS). Thirteen reports dealt with the effect of immunosuppressive treatment with myocarditis; 7 studies included an untreated control group, summing up 119 patients. Mortality did not differ between these groups: 31.3% and 30.9%, respectively (p = NS). It is concluded that 1) there are very few controlled and conclusive reports available on the prognostic value of endomyocardial biopsy and immunosuppressive treatment in idiopathic dilated cardiomyopathy; 2) the presence of inflammatory changes did not worsen the prognosis; and 3) immunosuppressive treatment did not improve survival.