Buja Louis Maximilian, Ottaviani Giulia, Ilic Milica, Zhao Bihong, Lelenwa Laura C, Segura Ana Maria, Bai Yu, Chen Alice, Akkanti Bindu, Hussain Rahat, Nathan Sriram, Petrovic Marija, Radovancevic Rajko, Gregoric Igor D, Kar Biswajit
Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Cardiovascular Pathology Research Laboratory, Texas Heart Institute, CHI St. Luke's Hospital, Houston, TX, USA.
Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA; Lino Rossi Research Center, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
Cardiovasc Pathol. 2020 Mar-Apr;45:107190. doi: 10.1016/j.carpath.2019.107190. Epub 2019 Dec 2.
Myocarditis continues to present challenges in diagnosis and management. The goal of this study is to determine the occurrence and manifestations of myocarditis in a heart failure (HF) population. The analyzed patients had acute or persistent HF and were referred over a 6-year period to a quaternary HF center for advanced HF therapies including mechanical circulatory support, left ventricular assist device (LVAD) implantation, and/or heart transplantation. The histopathological diagnosis of myocarditis was made based on the presence of an inflammatory infiltrate of the myocardium, typically with associated cardiomyocyte (CMC) damage, combined as indicated with immunohistochemical and molecular biology characterization. The pathological findings were correlated with a panel of clinical parameters and clinical course of the patients. Myocarditis was identified in 36 patients, with initial diagnoses made in 10 (40%) of 25 by endomyocardial biopsy (EMB), 1 by atrial biopsy (maze procedure), 7 (2.1%) of 331 at LVAD implantation, and 18 (7.8%) of 229 in the explanted heart. There were 20 cases of lymphocytic myocarditis, 4 cases of giant cell myocarditis, 3 cases of eosinophilic myocarditis, and 9 cases of lymphohistocytic with granulomas myocarditis - cardiac sarcoidosis. EMB was performed in 25 patients and was positive in 10 (40%) of cases. Myocarditis was found in 23 explanted hearts including 18 cases de novo and 5 cases with a previously positive specimen. Of the 23 explanted hearts, 21 were nonischemic cardiomyopathy and 2 were ischemic cardiomyopathy. Our findings show that, in patients presenting to a quaternary medical center, myocarditis can be manifest as acute HF as well as a complicating factor in chronic HF.
心肌炎在诊断和治疗方面仍然存在挑战。本研究的目的是确定心力衰竭（HF）人群中心肌炎的发生率和表现。分析的患者患有急性或持续性HF，并在6年期间被转诊至四级HF中心接受包括机械循环支持、左心室辅助装置（LVAD）植入和/或心脏移植在内的晚期HF治疗。心肌炎的组织病理学诊断基于心肌存在炎性浸润，通常伴有相关的心肌细胞（CMC）损伤，并结合免疫组织化学和分子生物学特征进行判断。病理结果与一组临床参数及患者的临床病程相关。36例患者被确诊为心肌炎，其中25例中有10例（40%）通过心内膜心肌活检（EMB）初步诊断，1例通过心房活检（迷宫手术）诊断，331例LVAD植入患者中有7例（2.1%）诊断为心肌炎，229例移植心脏中有18例（7.8%）诊断为心肌炎。有20例淋巴细胞性心肌炎，4例巨细胞性心肌炎，3例嗜酸性粒细胞性心肌炎，9例淋巴细胞组织细胞性伴肉芽肿性心肌炎——心脏结节病。25例患者进行了EMB检查，其中10例（40%）呈阳性。在23例移植心脏中发现了心肌炎，包括18例新发病例和5例之前标本呈阳性的病例。在23例移植心脏中，21例为非缺血性心肌病，2例为缺血性心肌病。我们的研究结果表明，在就诊于四级医疗中心的患者中，心肌炎可表现为急性HF以及慢性HF的一个并发症因素。
