Inflammatory Cardiomyopathy (ICM): Long-Term Survival after Heart Transplantation or Implantation of Mechanical Circulatory Support

Abstract

Purpose To investigate outcome of patients with giant cell myocarditis (GCM) or cardiac sarcoidosis (CS) who undergo heart transplantation (HTx) or implantation of mechanical circulatory support (MCS). Methods Data from all patients who received HTx or MCS due to GCM or CS at Sahlgrenska University Hospital (SU), Gothenburg between 1990s and 2018 was reviewed. The long-term survival was compared to 130 controls that were treated with HTx due to all other heart diseases, 5 for each patient with inflammatory cardiomyopathy (ICM), matched by age, sex and HTx duration. Results A total of 26 patients underwent HTx or received MCS because of GCM or CS at SU during the study period. Fifteen of them (58%) suffered from GCM and 11 from CS. Diagnosis was made by endomyocardial biopsy in 10/15 (67%) patients with GCM and 4/11 (36%) patients with CS and the remaining at the time of the pathological investigation of the heart explant. Altogether 8/15 (53%) of GCM patients and 2/11 (18%) required implantation of durable MCS, but 2 patients with GCM died before HTx. During follow-up disease recurrence in the graft was identified in 2/13 (15%) patients with GCM as well as in 2/11 (18%) CS patients. Treatment-requiring cardiac allograft rejection was observed in 6/13 (46%) GCM patients and in 1/11 (9%) CS patients. The mean survival time was numerically higher for patients with ICM (20.2 years, 95 % CI=12.2-28.2) than for the control group (16.9 years, 95 % CI=14.5-19.4), but the difference was not statistically significant (log-rank test (p=0.75) Breslow-test (p=0.68)). Conclusion Patients with GCM or CS with advanced heart failure who are treated with HTx or MCS have similar long-term survival as HTx recipients treated due to all other heart diseases.