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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
Issue Date
Acute Disease ; Adult ; Azo Compounds ; Biomarkers/analysis ; Biopsy ; Coloring Agents ; Eosine Yellowish-(YS) ; Eosinophils/pathology ; Female ; Fibrosis ; Humans ; Immunohistochemistry ; Kaplan-Meier Estimate ; Lymphocytes/pathology ; Male ; Methyl Green ; Middle Aged ; Myocarditis/metabolism ; Myocarditis/mortality ; Myocarditis/pathology* ; Myocardium/chemistry ; Myocardium/pathology* ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; Risk Factors ; Staining and Labeling/methods ; Time Factors ; Young Adult
Diagnosis ; Endomyocardial biopsy ; Histopathology ; Myocarditis ; Prognosis
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
Kang, Seok Min(강석민) ORCID logo https://orcid.org/0000-0001-9856-9227
Park, Sung Ha(박성하) ORCID logo https://orcid.org/0000-0001-5362-478X
Shim, Hyo Sup(심효섭) ORCID logo https://orcid.org/0000-0002-5718-3624
Oh, Jae Won(오재원) ORCID logo https://orcid.org/0000-0002-4585-1488
Youn, Jong Chan(윤종찬)
Lee, Sang Hak(이상학) ORCID logo https://orcid.org/0000-0002-4535-3745
Lee, Jae Seok(이재석)
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
Chung, Nam Sik(정남식)
Ji, Ah Young(지아영)
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
Hong, Nam Ki(홍남기) ORCID logo https://orcid.org/0000-0002-8246-1956
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