B. Lauer et al., Antimyosin autoantibodies are associated with deterioration of systolic and diastolic left ventricular function in patients with chronic myocarditis, J AM COL C, 35(1), 2000, pp. 11-18
Citations number
51
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
OBJECTIVES The study evaluates the clinical course and the development of s
ystolic and diastolic left ventricular function in patients with chronic my
ocarditis with or without autoantibodies against cardiac myosin.
BACKGROUND Patients with myocarditis often show autoantibodies against card
iac myosin. The clinical and pathophysiologic significance of these antimyo
sin autoantibodies (AMAAB) is yet unknown. The results from studies compari
ng the clinical course and the development of left ventricular function in
patients with chronic myocarditis with or without AMAAB are not yet availab
le.
METHODS Thirty-three patients with biopsy proven chronic myocarditis underw
ent analysis of AMAAB, right and left heart catheterization and left ventri
culography at baseline and after six months. Left ventricular volumes and e
jection fraction as well as the time constant of left ventricular relaxatio
n "tau" and the constant of myocardial stiffness "b" were determined at bas
eline and at follow-up.
RESULTS In 17 (52%) patients, AMAAB could be detected at baseline. After si
x months, AMAAB were still found in 13 (76%) initially antibody-positive pa
tients. No initially antibody-negative (n = 16) patient developed AMAAB dur
ing follow up. Clinical symptoms improved slightly in antibody-negative pat
ients and remained stable in antibody-positive patients. Left ventricular e
jection fraction developed significantly better in antibody-negative patien
ts (+8.9 +/- 10.1%) compared with antibody-positive patients (-0.1 +/- 9.4%
) (p < 0.012). Stroke volume (SV) and stroke volume index (SVI) also improv
ed in antibody-negative patients (SV: +20 +/- 31 mi; SVI: +10 +/- 17 mi) co
mpared with antibody-positive patients (SV: -14 +/- 43 ml; SVI: -8 +/- 22 m
l) (SV: p < 0.015; SVI: p < 0.016). Left ventricular end-diastolic and end-
systolic volumes and the time constant of left ventricular relaxation "tau"
did not change significantly different in antibody-positive and antibody-n
egative patients. The constant of myocardial stiffness "b" improved signifi
cantly in antibody-negative patients (-6.1 +/- 10.8) compared with antibody
-positive patients (+7.3 +/- 22.6) (p < 0.040). Analyzing only the persiste
ntly antibody-positive patients yielded essentially the same results.
CONCLUSIONS Antimyosin autoantibodies are associated with worse development
of left ventricular systolic function and diastolic stiffness in patients
with chronic myocarditis. (C) 1999 by the American College of Cardiology.