Immunosuppressive Therapy in Myocarditis. Circulation Journal: Official Journal of the Japanese Circulation Society. 2015, –(79), 4-7.
The effect of immunosuppressive therapy lies in the suppression of the immune system reaction. The possibilities to use immunosuppressants in the therapy of myocarditis and inflammatory dilated cardiomyopathy are influenced by the presence of the virus in the heart muscle tissue. In patients with detected genetical information of a virus in the heart muscle, immunosuppressive therapy cannot be indicated. It could even cause deterioration of a patient´s state of health.
For this reason, immunosuppressive therapy in indicated just in patients without the presence of the genetic information of the virus in the heart muscle. It is also indicated in certain types of myocarditis like for example giant cell and hypersensitive eosinophilic myocarditis or in myocarditis connected with systematic disorders.
For the indication of the immunosuppressive therapy, the results of the endomyocardial biopsy are crucial.
This specific research had two parts – so-called retrospective (there were investigated cases “from past”) and prospective (patients were studied “in present”). The effect of immunosuppressive therapy was investigated in patients with chronic myocarditis and inflammatory cardiomyopathy (see this article). In these studies, patients were categorized into two groups – one got immunosuppressive therapy (specifically prednisone and azathioprine) and the other got placebo and standard heart failure therapy.
In most of the patients in the groups that got immunosuppressants, there was observed improvement of the heart function in both studies. Ejection fraction of the left ventricle increased and dilatation (“enlargement”) of the heart chambers decreased. In the group of patients with placebo, their state of health remained the same or got worse.
Authors of this research tried to explain the effect of immunosuppressant at the cellular level. In their conclusion, they presume that the improvement of patients´ state of health after immunosuppressive therapy was caused by the suppression of degradation and cell death, of activation of cellular proliferation (increase in cell numbers) and the production of new cellular components (contractile elements) important for the right function and contractility of the heart.
Therapy with immunosuppressants takes place in specialized centres. Currently, there is a study in General University Hospital investigating the effect of immunosuppressive therapy in inflammatory cardiomyopathy.
Author of the opening picture: Edelhart~commonswiki
