Management of Patients With Giant Cell Myocarditis JACC Review Topic of the Week

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:77

Review

Bang, Vigyan¹  Ganatra, Sarju¹  Shah, Sachin P.¹  Dani, Sourbha S.¹  Neilan, Tomas G.^2,3  Thavendiranathan, Paaladinesh^4,5  Resnic, Frederic S.¹  Piemonte, Thomas C.¹  Barac, Ana⁶  Patel, Rushin¹  Sharma, Ajay¹  Parikh, Rohan¹  Chaudhry, Ghulam M.¹  Vesely, Mark⁷  Hayek, Salim S.⁸  Leja, Monika⁸  Venesy, David¹  Patten, Richard¹  Lenihan, Daniel⁹  Nohria, Anju¹⁰  Cooper, Leslie T.¹¹ 

[1] Lahey Hosp & Med Ctr, Dept Cardiovasc Med, 41 Mall Rd, Burlington, MA 01805 USA

[2] Massachusetts Gen Hosp, Cardiovasc Imaging Res Ctr CIRC, Boston, MA 02114 USA

[3] Massachusetts Gen Hosp, Cardiooncol Program, Boston, MA 02114 USA

[4] Univ Toronto, Univ Hlth Network, Toronto Gen Hosp, Peter Munk Cardiac Ctr,Div Cardiol, Toronto, ON, Canada

[5] Univ Toronto, Univ Hlth Network, Toronto Gen Hosp, Peter Munk Cardiac Ctr,Joint Div Med Imaging, Toronto, ON, Canada

[6] MedStar Washington Hosp Ctr, MedStar Heart & Vasc Inst, Dept Cardiol, Washington, DC USA

[7] Univ Maryland, Med Ctr, Dept Cardiovasc Med, Baltimore, MD 21201 USA

[8] Univ Michigan, Div Cardiovasc Med, Ann Arbor, MI 48109 USA

[9] Washington Univ, Dept Med, Div Cardiovasc Med, St Louis, MO USA

[10] Brigham & Womens Hosp, Dept Cardiovasc Med, Div Adv Heart Failure, 75 Francis St, Boston, MA 02115 USA

[11] Mayo Clin, Dept Cardiovasc Med, Jacksonville, FL 32224 USA

关键词: endomyocardial biopsy;    giant cell myocarditis;    heart block;    heart failure;    heart transplant;    immunosuppression;    left ventricular assist device;    ventricular arrhythmia;    cardiogenic shock;   

DOI  :  10.1016/j.jacc.2020.11.074

来源: Elsevier

【 摘 要 】

Giant cell myocarditis is a rare, often rapidly progressive and potentially fatal, disease due to T-cell lymphocyte-mediated inflammation of the myocardium that typically affects young and middle-aged adults. Frequently, the disease course is marked by acute heart failure, cardiogenic shock, intractable ventricular arrhythmias, and/or heart block. Diagnosis is often difficult due to its varied clinical presentation and overlap with other cardiovascular conditions. Although cardiac biomarkers and multimodality imaging are often used as initial diagnostic tests, endomyocardial biopsy is required for definitive diagnosis. Combination immunosuppressive therapy, along with guideline-directed medical therapy, has led to a paradigm shift in the management of giant cell myocarditis resulting in an improvement in overall and transplant-free survival. Early diagnosis and prompt management can decrease the risk of transplantation or death, which remain common in patients who present with cardiogenic shock.

【 授权许可】

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