Changes in histology and left ventricular ejection fraction during immunoSuppressive treatment in active myocarditis

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Abstract
Active myocarditis was diagnosed in 17 out of 295 patients who underwent endomyocardial biopsy. To evaluate the effects of prednisone (50 mg m−2 day−1, then tapered) and azathioprine (75 mg m−2 day−1), patients were controlled with endomyocurdial biopsy and ejection fraction measurement during the minimum treatment period of 6 months. After 2 months of treatment, persistent myocarditis was present in only three patients while healing or healed myocarditis was present in eight and six patients, respectively. Continuous treatment was associated with the disappearance of the histological signs of myocarditis in 14 patients. The subsequent reduction or interruption of the treatment was associated with a worsening histology in ten patients. Ejection fraction estimated at the end of the treatment period (six patients) or at the latest follow-up (11 patients) improved from 37.8 ± 14% to 44.8 ± 17.6%, P = 0.031. Thus, immunoSuppressive treatment was associated with a reduction of the histological signs of myocarditis in most patients. A concomitant, significant improvement of ejection fraction was observed.

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