Bacal, Fernando

Benvenuti, Luiz Alberto

Braga, Fabiana Goulart Marcondes

Gaiotto, Fábio Antônio

Oliveira, Vinícius Vitor de

English

Cadernos Espinosanos (E-Journal)

17Awards of the XXXVI COMU 2017. Rev Med (São Paulo). 2017;96(Suppl. 1):1-35.Assessment of the impact of eosinophilic myocarditis in patients underwent heart transplant in use inotropic drugsAcademic authors: Vinícius Vitor de OliveiraAcademic advisors: Fabiana Goulart Marcondes Braga, Luiz Alberto Benvenuti,  Fábio Antônio Gaiotto, Fernando BacalIntroduction: The Eosinophilic Myocarditis (EM) is a rare myocardial disorder caused by hypersensitivity reaction, but it has a higher frequency in patients on hearts transplant waiting list, probably due to prolonged use of dobutamine. EM can worsen the state of the patient with congestive heart failure, because they already have low cardiac reserve. Furthermore, its variable clinical manifestation and non-specific heart signs make the antemortem diagnosis difficult.Objectives: To evaluate the incidence of EM in patients underwent heart transplant, correlate with clinical evolution, use of dobutamine, etiology of heart disease, post-transplant rejection and death.Methods: A survey of medical records data was performed from patients transplanted between January 2013 and June 2016. The criteria for clinical worsening were the need for dobutamine increase, association with Milrinone and intra-aortic balloon implantation. Explanted hearts were reviewed in search of eosinophilic infiltration the myocardium. When this infiltration exceeded 50% it was considered EM. Subsequently, it was classified as mild, moderate and intense.Results: Among all the transplanted patients (n= 138), 19% (13,8%) presented eosinophilic infiltrate and 11 (8% of the total) were classified as EM, being mild (3), moderate (6) and intense (2). Among patients who received dobutamine (n= 118), was noticed EM in 9,3%. The profile of the patients with EM was evaluated mid those who received dobutamine (see table). Sex; Age; Etiology; Time, final dose and increase of dobutamine; Association with Milrinone; Use of intra-aortic balloon; Ejection fraction and LVDD; 2R or greater cell rejection and death did not have statistically significant differences. Blood eosinophilia occurred in 11 (100%) with a significant difference compared to the group without EM.Conclusions: The presence of eosinophilic myocarditis, although not infrequent, did not affect mortality and rejection rates. Blood eosinophilia was an important feature found in all cases of EM.Keywords: Eosinophilic myocarditis; Heart transplant; Heart disease.18Awards of the XXXVI COMU 2017.Rev Med (São Paulo). 2017;96(Suppl. 1):1-35.Table.Eosinophilic MyocarditisVariables Absent Present pSex n (%) 72 (67,3) 5 (45,5) 0,148Age (years) 45,2±12,8 48,2±9,6 0,463Etiology n (%) 0,661Dilated 32 (29,9%) 5 (45,5%)Ischemic 17 (15,9%) 2 (18,2%)Chagasic 41 (38,3%) 2 (18,2%)Valvar 3 (2,8%) 0Others 14 (13,1%) 3 (18,2%)Time of Dobutamine (days) 70,7±68,7 38,7±26,8 0,130Increase dobutamine dose on admission n (%) 78 (75%) 10 (90,9%) 0,236Final dose of Dobutamine (mcg/kg/min) 14,6±6,2 11,4±6,3 0,101Association with Milrinone n (%) 35 (32,7%) 3 (27,3%) 0,713Use of intra-aortic balloon n (%) 63 (58,9%) 3 (27,3%) 0,044Eosinophilia (>5 %) n (%) 51 (47,7%) 11 (100%) 0,001Ejection Fraction (%) 25,2±8,4 27,9±10,9 0,353Left Ventricular Diastolic Diameter (mm) n(%) 69,8±11,1 68,3±10,5 0,684Cell Rejection ≥ 2R in first biopsy n (%) 32 (35%) 3 (30%) 0,762Death on admission n (%) 22 (20,6%) 1 (9,1%) 0,360

Assessment of the impact of eosinophilic myocarditis in patients underwent heart transplant in use inotropic drugs

https://www.revistas.usp.br/revistadc/article/download/138605/133989

Assessment of the impact of eosinophilic myocarditis in patients underwent heart transplant in use inotropic drugs

Abstract

Similar works

Full text

Available Versions

Cadernos Espinosanos (E-Journal)