From the Cardiology Department (J.M., M.H., J.V., V.V.E., C.K., H.-P.B.-L.R., S.H.), Immunology Department (P.V.P.), and Pathology Department (M.A.H.), Maastricht University Medical Center, The Netherlands; and Clinical Division of Cardiology and Angiology (M.S., J.K., P.H., G.P.) and Institute of Pathology (C.E.), Innsbruck Medical University, Austria.
Circ Heart Fail. 2018 Feb;11(2):e004228. doi: 10.1161/CIRCHEARTFAILURE.117.004228.
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.
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). 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 =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; =0.036).
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.
炎症性心肌病（infl-CMP）的特征是在没有病毒、缺血、瓣膜病或其他明显原因的情况下，心脏炎症增加。关于免疫抑制疗法在 infl-CMP 患者中的疗效的研究很少。本研究回顾性调查了在当前指南指导下的心力衰竭治疗基础上加用免疫抑制剂是否能改善 infl-CMP 患者的心脏功能和长期预后。
在因斯布鲁克和马斯特里赫特心肌病注册中心，共有 209 名患者通过心内膜心肌活检（≥14 个浸润性炎症细胞/mm）符合 infl-CMP 的标准。共有 110 名（53%）患者接受了免疫抑制治疗，99 名（47%）未接受。为了纠正潜在的选择偏倚，对所有显著的基线参数进行了 1:1 倾向评分匹配，每组共有 90 名患者。两组患者的基线特征无显著差异，反映了最佳的倾向评分匹配。中位随访 31（15-47）个月后，与单独标准心力衰竭治疗相比，免疫抑制治疗可改善长期预后（如，心脏移植无事件生存率）（Log-rank =0.043；风险比，0.34 [95%CI，0.17-0.92]），并且在平均 12 个月随访后左心室射血分数的增加幅度明显更大，与仅接受标准心力衰竭治疗的患者相比（分别为 12.2%和 7.3%；=0.036）。
总之，本研究表明，与单独标准心力衰竭治疗相比，免疫抑制疗法可使 infl-CMP 患者的心脏移植无事件生存率得到改善，这突显了进行大型前瞻性多中心试验的迫切需要。
