Davidoff R, Palacios I, Southern J, Fallon J T, Newell J, Dec G W
Evans Memorial Department of Clinical Research, Boston University Medical Center, Mass.
Circulation. 1991 Mar;83(3):953-61. doi: 10.1161/01.cir.83.3.953.
Giant cell myocarditis has rarely been diagnosed premortem, and little is known about its natural history. In addition, no comparative studies with lymphocytic myocarditis exist.
The clinical features, serial change in left ventricular fraction (LVEF), and outcomes of all patients with histologically verified myocarditis were retrospectively evaluated. Ten patients (22%) were found to have giant cell myocarditis (group 1), whereas the remaining 36 (78%) had lymphocytic myocarditis (group 2). Age at presentation, gender distribution, duration of symptoms, initial LVEF, and resting hemodynamics did not differ between groups. Ventricular tachycardia was detected in 90% of group 1 patients compared with only 25% of group 2 (p = 0.0007). Atrioventricular block that required pacemaker insertion was also more common in group 1 (60%) than in group 2 (8.3%) (p = 0.001). Left ventricular systolic function declined during follow-up in group 1 patients (LVEF, 0.43 +/- 0.07-0.26 +/- 0.05, p = 0.11) but increased in group 2 patients (LVEF, 0.33 +/- 0.03-0.41 +/- 0.03, p = 0.02). When the net change between initial and final LVEF was assessed, a significant difference was evident (giant cell group, -0.17 +/- 0.06; lymphocytic group, +0.07 +/- 0.03; p = 0.0008). Although a greater proportion of patients in group 1 died or required transplantation (seven of 10 versus 11 of 36, p = 0.03), actuarial survival over 4 years was not different for the giant cell group (50%) than for the lymphocytic group (62%).
Giant cell myocarditis was more prevalent than previously recognized and highly associated with both ventricular tachycardia and pacemaker requirement. The likelihood of an adverse event, either cardiovascular mortality or cardiac transplantation, was significantly greater for patients with giant cell myocarditis than for those with lymphocytic myocarditis, perhaps because of the progressive decline in left ventricular systolic function that was observed in those with giant cell myocarditis.
巨细胞性心肌炎生前很少被诊断出来，对其自然病史了解甚少。此外，尚无与淋巴细胞性心肌炎的对比研究。
对所有经组织学证实的心肌炎患者的临床特征、左心室射血分数（LVEF）的系列变化及转归进行回顾性评估。发现10例患者（22%）患有巨细胞性心肌炎（第1组），其余36例（78%）患有淋巴细胞性心肌炎（第2组）。两组患者的就诊年龄、性别分布、症状持续时间、初始LVEF及静息血流动力学无差异。第1组90%的患者检测到室性心动过速，而第2组仅为25%（p = 0.0007）。需要植入起搏器的房室传导阻滞在第1组（60%）也比第2组（8.3%）更常见（p = 0.001）。第1组患者随访期间左心室收缩功能下降（LVEF，0.43±0.07至0.26±0.05，p = 0.11），而第2组患者左心室收缩功能增加（LVEF，0.33±0.03至0.41±0.03，p = 0.02）。当评估初始和最终LVEF之间的净变化时，差异显著（巨细胞组，-0.17±0.06；淋巴细胞组，+0.07±0.03；p = 0.0008）。虽然第1组中死亡或需要移植的患者比例更高（10例中的7例对36例中的11例，p = 0.03），但巨细胞组4年的精算生存率（50%）与淋巴细胞组（62%）并无差异。
巨细胞性心肌炎比之前认为的更常见，且与室性心动过速和起搏器需求高度相关。巨细胞性心肌炎患者发生心血管死亡或心脏移植等不良事件的可能性显著高于淋巴细胞性心肌炎患者，这可能是因为巨细胞性心肌炎患者左心室收缩功能呈进行性下降。
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