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Detailed pathologic evaluation on endomyocardial biopsy provides long-term prognostic information in patients with acute myocarditis

 Jong-Chan Youn  ;  Hyo Sup Shim  ;  Jae Seok Lee  ;  Ah-Young Ji  ;  Jaewon Oh  ;  Namki Hong  ;  Hye Sun Lee  ;  Sungha Park  ;  Sang-Hak Lee  ;  Donghoon Choi  ;  Namsik Chung  ;  Seok-Min Kang 
 Cardiovascular Pathology, Vol.23(3) : 139-144, 2014 
Journal Title
 Cardiovascular Pathology 
Issue Date
BACKGROUND: The long-term prognosis of biopsy-proven myocarditis is not well known. We hypothesized that a detailed pathological examination of an endomyocardial biopsy (EMB) would reveal prognostic information in patients with acute myocarditis. METHODS: Fifty-four patients were diagnosed with acute myocarditis based on an EMB. Pathological diagnosis was categorized into lymphocytic dominant (29.6%), eosinophilic dominant (22.2%), and borderline myocarditis (48.1%). Masson's trichrome staining and further immunohistochemical staining for CD3, CD20, CD68, HLA-DR, TLR4, TLR8, enteroviral VP1, and caspase-3 expression were performed. The clinical outcomes were defined as all-cause and cardiovascular (CV) death. RESULTS: During the median 10.4 years of follow up (9.7±5.7 years), the overall all-cause mortality was 20.4% and the CV mortality was 14.8% in patients with acute myocarditis. Lymphocytic dominant myocarditis patients showed a poor clinical outcome when compared with eosinophilic dominant myocarditis patients for both all-cause (37.5% vs. 0%, p=0.015) and CV (31.2% vs. 0%, p=0.029) mortality. Among borderline myocarditis patients, the presence of fibrosis was linked with poor clinical outcomes in both all-cause (75.0% vs. 21.4%, p=0.045) and CV (100.0% vs. 25.0%, p=0.034) mortality. No significant associations between clinical outcome and all other immunohistochemical staining targets were observed. CONCLUSIONS: Detailed pathological evaluation on an EMB provides prognostic information in patients with acute myocarditis. EMB evaluation should be considered in patients with suspected myocarditis.
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1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
강석민(Kang, Seok Min) ORCID logo https://orcid.org/0000-0001-9856-9227
박성하(Park, Sung Ha) ORCID logo https://orcid.org/0000-0001-5362-478X
심효섭(Shim, Hyo Sup) ORCID logo https://orcid.org/0000-0002-5718-3624
오재원(Oh, Jae Won) ORCID logo https://orcid.org/0000-0002-4585-1488
윤종찬(Youn, Jong Chan)
이상학(Lee, Sang Hak) ORCID logo https://orcid.org/0000-0002-4535-3745
이재석(Lee, Jae Seok)
이혜선(Lee, Hye Sun) ORCID logo https://orcid.org/0000-0001-6328-6948
정남식(Chung, Nam Sik)
지아영(Ji, Ah Young)
최동훈(Choi, Dong Hoon) ORCID logo https://orcid.org/0000-0002-2009-9760
홍남기(Hong, Nam Ki) ORCID logo https://orcid.org/0000-0002-8246-1956
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