Cargando…
Outcomes of Mechanical Circulatory Support for Giant Cell Myocarditis: A Systematic Review
Treatment of giant cell myocarditis (GCM) can require bridging to orthotopic heart transplantation (OHT) or recovery with mechanical circulatory support (MCS). Since the roles of MCS and immunotherapy are not well-defined in GCM, we sought to analyze outcomes of patients with GCM who required MCS. A...
Autores principales: | , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761005/ https://www.ncbi.nlm.nih.gov/pubmed/33271929 http://dx.doi.org/10.3390/jcm9123905 |
_version_ | 1783627466645962752 |
---|---|
author | Patel, Preeyal M. Saxena, Abhiraj Wood, Chelsey T. O’Malley, Thomas J. Maynes, Elizabeth J. Entwistle, John W. C. Massey, H. Todd Pirlamarla, Preethi R. Alvarez, René J. Cooper, Leslie T. Rame, J. Eduardo Tchantchaleishvili, Vakhtang |
author_facet | Patel, Preeyal M. Saxena, Abhiraj Wood, Chelsey T. O’Malley, Thomas J. Maynes, Elizabeth J. Entwistle, John W. C. Massey, H. Todd Pirlamarla, Preethi R. Alvarez, René J. Cooper, Leslie T. Rame, J. Eduardo Tchantchaleishvili, Vakhtang |
author_sort | Patel, Preeyal M. |
collection | PubMed |
description | Treatment of giant cell myocarditis (GCM) can require bridging to orthotopic heart transplantation (OHT) or recovery with mechanical circulatory support (MCS). Since the roles of MCS and immunotherapy are not well-defined in GCM, we sought to analyze outcomes of patients with GCM who required MCS. A systematic search was performed in June 2019 to identify all studies of biopsy-proven GCM requiring MCS after 2009. We identified 27 studies with 43 patients. Patient-level data were extracted for analysis. Median patient age was 45 (interquartile range (IQR): 32–57) years. 42.1% (16/38) were female. 34.9% (15/43) presented in acute heart failure. 20.9% (9/43) presented in cardiogenic shock. Biventricular (BiVAD) MCS was required in 76.7% (33/43) of cases. Of the 62.8% (27/43) of patients who received immunotherapy, 81.5% (22/27) used steroids combined with at least one other immunosuppressant. Cyclosporine was the most common non-steroidal agent, used in 40.7% (11/27) of regimens. Immunosuppression was initiated before MCS in 59.3% (16/27) of cases, after MCS in 29.6% (8/27), and not specified in 11.1% (3/27). Immunosuppression started prior to MCS was associated with significantly better survival than MCS alone (p = 0.006); 60.5% (26/43) of patients received bridge-to-transplant MCS; 39.5% (17/43) received bridge-to-recovery MCS; 58.5% (24/41) underwent OHT a median of 104 (58–255) days from diagnosis. GCM recurrence after OHT was reported in 8.3% (2/24) of transplanted cases. BiVAD predominates in mechanically supported patients with GCM. Survival and bridge to recovery appear better in patients on immunosuppression, especially if initiated before MCS. |
format | Online Article Text |
id | pubmed-7761005 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-77610052020-12-26 Outcomes of Mechanical Circulatory Support for Giant Cell Myocarditis: A Systematic Review Patel, Preeyal M. Saxena, Abhiraj Wood, Chelsey T. O’Malley, Thomas J. Maynes, Elizabeth J. Entwistle, John W. C. Massey, H. Todd Pirlamarla, Preethi R. Alvarez, René J. Cooper, Leslie T. Rame, J. Eduardo Tchantchaleishvili, Vakhtang J Clin Med Article Treatment of giant cell myocarditis (GCM) can require bridging to orthotopic heart transplantation (OHT) or recovery with mechanical circulatory support (MCS). Since the roles of MCS and immunotherapy are not well-defined in GCM, we sought to analyze outcomes of patients with GCM who required MCS. A systematic search was performed in June 2019 to identify all studies of biopsy-proven GCM requiring MCS after 2009. We identified 27 studies with 43 patients. Patient-level data were extracted for analysis. Median patient age was 45 (interquartile range (IQR): 32–57) years. 42.1% (16/38) were female. 34.9% (15/43) presented in acute heart failure. 20.9% (9/43) presented in cardiogenic shock. Biventricular (BiVAD) MCS was required in 76.7% (33/43) of cases. Of the 62.8% (27/43) of patients who received immunotherapy, 81.5% (22/27) used steroids combined with at least one other immunosuppressant. Cyclosporine was the most common non-steroidal agent, used in 40.7% (11/27) of regimens. Immunosuppression was initiated before MCS in 59.3% (16/27) of cases, after MCS in 29.6% (8/27), and not specified in 11.1% (3/27). Immunosuppression started prior to MCS was associated with significantly better survival than MCS alone (p = 0.006); 60.5% (26/43) of patients received bridge-to-transplant MCS; 39.5% (17/43) received bridge-to-recovery MCS; 58.5% (24/41) underwent OHT a median of 104 (58–255) days from diagnosis. GCM recurrence after OHT was reported in 8.3% (2/24) of transplanted cases. BiVAD predominates in mechanically supported patients with GCM. Survival and bridge to recovery appear better in patients on immunosuppression, especially if initiated before MCS. MDPI 2020-12-01 /pmc/articles/PMC7761005/ /pubmed/33271929 http://dx.doi.org/10.3390/jcm9123905 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Patel, Preeyal M. Saxena, Abhiraj Wood, Chelsey T. O’Malley, Thomas J. Maynes, Elizabeth J. Entwistle, John W. C. Massey, H. Todd Pirlamarla, Preethi R. Alvarez, René J. Cooper, Leslie T. Rame, J. Eduardo Tchantchaleishvili, Vakhtang Outcomes of Mechanical Circulatory Support for Giant Cell Myocarditis: A Systematic Review |
title | Outcomes of Mechanical Circulatory Support for Giant Cell Myocarditis: A Systematic Review |
title_full | Outcomes of Mechanical Circulatory Support for Giant Cell Myocarditis: A Systematic Review |
title_fullStr | Outcomes of Mechanical Circulatory Support for Giant Cell Myocarditis: A Systematic Review |
title_full_unstemmed | Outcomes of Mechanical Circulatory Support for Giant Cell Myocarditis: A Systematic Review |
title_short | Outcomes of Mechanical Circulatory Support for Giant Cell Myocarditis: A Systematic Review |
title_sort | outcomes of mechanical circulatory support for giant cell myocarditis: a systematic review |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761005/ https://www.ncbi.nlm.nih.gov/pubmed/33271929 http://dx.doi.org/10.3390/jcm9123905 |
work_keys_str_mv | AT patelpreeyalm outcomesofmechanicalcirculatorysupportforgiantcellmyocarditisasystematicreview AT saxenaabhiraj outcomesofmechanicalcirculatorysupportforgiantcellmyocarditisasystematicreview AT woodchelseyt outcomesofmechanicalcirculatorysupportforgiantcellmyocarditisasystematicreview AT omalleythomasj outcomesofmechanicalcirculatorysupportforgiantcellmyocarditisasystematicreview AT mayneselizabethj outcomesofmechanicalcirculatorysupportforgiantcellmyocarditisasystematicreview AT entwistlejohnwc outcomesofmechanicalcirculatorysupportforgiantcellmyocarditisasystematicreview AT masseyhtodd outcomesofmechanicalcirculatorysupportforgiantcellmyocarditisasystematicreview AT pirlamarlapreethir outcomesofmechanicalcirculatorysupportforgiantcellmyocarditisasystematicreview AT alvarezrenej outcomesofmechanicalcirculatorysupportforgiantcellmyocarditisasystematicreview AT cooperlesliet outcomesofmechanicalcirculatorysupportforgiantcellmyocarditisasystematicreview AT ramejeduardo outcomesofmechanicalcirculatorysupportforgiantcellmyocarditisasystematicreview AT tchantchaleishvilivakhtang outcomesofmechanicalcirculatorysupportforgiantcellmyocarditisasystematicreview |