Predictors of long-term outcome in patients with biopsy proven inflamma-tory cardiomyopathy

Background The objective of this study was to identify prognostic indicators in patients with inflammatory cardiomyopathy (iCM) on endomyocardial biopsy (EMB). Methods and results Between 2007 and 2011 all consecutive patients with diagnosed with iCM at EMB were retrospectively analyzed. The combined primary endpoint (EP) (1°EP) was cardiac death, aborted sudden cardiac death/appropriate implantable cardioverter defibrillator (ICD) shock, progressive heart failure requiring left ventricular assist device (LVAD) implantation and heart transplantation. 503 patients (mean age 58 ± 12 years, 73% male) were available for analysis. Genomes of cardiotrophic viruses were detected in 396 patients (79%) and immuno-histochemical signs of inflammation were present in 223 individuals (44%). After 3.6 ± 2.4 years of follow-up, cardiac mortality was 3.0% (n = 14) and a total of 8.6% (n = 40) reached the primary endpoint. Independent predictors for the 1°EP were: age ≥ 50 years, presence and duration (≤ 28 days) of symptomatic heart failure. A risk stratification approach based on the results of the multivariate analysis demonstrated that absence of signs and/or symptoms of congestive heart failure in younger ( 28 days) duration of disease appear to have an excellent prognosis with 100% survival and no events during follow-up. The presence of all above mentioned independent risk factors results in an 1°EP occurrence of 35.9%. Conclusions Symptoms of heart failure, short duration of disease, and older age are indicators of poor outcome in patients with iCM.