TY - JOUR
T1 - Lack of objective improvement in ventricular systolic function in patients with myocarditis treated with azathioprine and prednisone
AU - Hosenpud, Jeffrey D.
AU - McAnulty, John H.
AU - Niles, Nelson R.
PY - 1985
Y1 - 1985
N2 - Six patients with myocarditis documented by biopsy, after a baseline right heart catheterization and echocardiogram, underwent treatment with azathioprine and prednisone. After 3 months of treatment, biopsy, right heart catheterization and echocardiogram were repeated. In addition to the immunosuppressive therapy, most patients received additional conventional medications for heart failure between evaluation periods (mean number of cardiac drugs increased from 1.7 ± 1.0 to 2.7 ± 0.05, p = 0.041). Mean heart rate decreased (105 ± 14 to 84 ± 13 beats/min, p = 0.016), as did pulmonary wedge pressure (23 ± 8 to 12 ± 4 mm Hg, p = 0.012). There were no significant changes in cardiac index (3.1 ± 0.8 to 2.9 ± 1.0 liters/min), end-diastolic dimension (62 ± 13 to 62 ± 12 mm) or fractional shortening (11 ± 6 to 12 ± 3%) with treatment. Complications from immunosuppressive therapy included severe soft tissue infection, acute psychosis and adrenal insufficiency in one patient each. The benefits from prednisone and azathioprine in this group of patients have not been demonstrated. Although heart rate and pulmonary wedge pressure decreased, these changes could be ascribed to increases in the conventional therapy for heart failure. Finally, there is a high incidence of side effects from prednisone and azathioprine therapy. These findings suggest that this unproven therapy for myocarditis should he limited to experimental protocols.
AB - Six patients with myocarditis documented by biopsy, after a baseline right heart catheterization and echocardiogram, underwent treatment with azathioprine and prednisone. After 3 months of treatment, biopsy, right heart catheterization and echocardiogram were repeated. In addition to the immunosuppressive therapy, most patients received additional conventional medications for heart failure between evaluation periods (mean number of cardiac drugs increased from 1.7 ± 1.0 to 2.7 ± 0.05, p = 0.041). Mean heart rate decreased (105 ± 14 to 84 ± 13 beats/min, p = 0.016), as did pulmonary wedge pressure (23 ± 8 to 12 ± 4 mm Hg, p = 0.012). There were no significant changes in cardiac index (3.1 ± 0.8 to 2.9 ± 1.0 liters/min), end-diastolic dimension (62 ± 13 to 62 ± 12 mm) or fractional shortening (11 ± 6 to 12 ± 3%) with treatment. Complications from immunosuppressive therapy included severe soft tissue infection, acute psychosis and adrenal insufficiency in one patient each. The benefits from prednisone and azathioprine in this group of patients have not been demonstrated. Although heart rate and pulmonary wedge pressure decreased, these changes could be ascribed to increases in the conventional therapy for heart failure. Finally, there is a high incidence of side effects from prednisone and azathioprine therapy. These findings suggest that this unproven therapy for myocarditis should he limited to experimental protocols.
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U2 - 10.1016/S0735-1097(85)80485-X
DO - 10.1016/S0735-1097(85)80485-X
M3 - Article
C2 - 4031294
AN - SCOPUS:0022389532
SN - 0735-1097
VL - 6
SP - 797
EP - 801
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 4
ER -