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Myocarditis pp 261-267 | Cite as

Immunosuppressive Therapy in Myocarditis: Lessons from Clinical Trials and Future Perspectives

  • Andrea FrustaciEmail author
  • Cristina Chimenti
Chapter
  • 67 Downloads

Abstract

While there is general agreement on the favorable impact of immunosuppression in eosinophilic, granulomatous, giant cell, drug hypersensitivity, connective tissue disorders, and cardiac rejection-associated myocarditis, its therapeutic role in inflammatory cardiomyopathy (ICM) is still debated. Previous retrospective studies reported a relevant clinical benefit in 90% of patients with virus-negative ICM and no response or cardiac impairment in 85% of patients with virus-positive ICM following immunosuppression. A randomized prospective double-blind trial using prednisone and azathioprine in addition to supportive treatment in virus-negative ICM reported a significant improvement of left ventricular ejection fraction and a significant reduction of LV dimensions in 88% of 43 treated patients compared with 42 patients receiving placebo who showed a cardiac impairment in 83% of cases (TIMIC study). These data have been confirmed by further and larger studies demonstrating a long-term control of myocardial inflammation and persistence of improved cardiac contractility.

Keywords

Myocarditis Inflammatory cardiomyopathy Endomyocardial biopsy Treatment Immunosuppressive therapy 

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Cardiovascular, Respiratory, Nephrologic, Geriatric and Anaesthesiologic SciencesLa Sapienza UniversityRomeItaly
  2. 2.IRCCS L. SpallanzaniRomeItaly

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