Although prednisone has been used to treat patients with idiopathic dilated cardiomyopathy, its efficacy has not been rigorously studied. We therefore randomly assigned 102 patients to either treatment with prednisone (60 mg per day) or a control group. At three months, improvement, defined prospectively as an increase in the ejection fraction of greater than or equal to 5 percentage points, was observed in 53 percent of the patients receiving prednisone and 27 percent of the controls (P = 0.005). The mean (+/- SE) ejection fraction increased 4.3 +/- 1.5 percentage points (from 17.9 +/- 1.0 to 22.2 +/- 1.6 percent) in the prednisone group, as compared with 2.1 +/- 0.8 percentage points (from 17.1 +/- 1.1 to 19.3 +/- 1.4 percent) in the control group (P = 0.054). All patients were categorized prospectively in two separately randomized subgroups. "Reactive" patients (n = 60) were those who had fibroblastic (n = 36) or lymphocytic (n = 2) infiltration or immunoglobulin deposition (n = 16) on endomyocardial biopsy, a positive gallium scan (n = 7), or an elevated erythrocyte sedimentation rate (n = 18). "Nonreactive" patients (n = 42) had none of these features. At three months, 67 percent of the reactive patients who received prednisone had improvement, as compared with 28 percent of the reactive controls (P = 0.004). Nonreactive patients did not improve significantly with prednisone (P = 0.51). After three months, reactive patients who received prednisone daily were switched to alternate-day therapy (60 mg every other day), and after six months the improvement seen earlier was no longer present. These data suggest that patients with idiopathic dilated cardiomyopathy may have some improvement when given a high dose of prednisone daily. However, the increases in the ejection fraction that we observed during prednisone treatment were small, their duration was limited, and the side effects were important. Overall, prednisone was judged to have only marginal clinical benefit, and should not be administered as standard therapy for dilated cardiomyopathy.
Source Information
Critical Care Medicine Department, National Heart, Lung, and Blood Institute, Bethesda, Md.
This article has been cited by other articles:
Dennert, R., Crijns, H. J., Heymans, S.
(2008). Acute viral myocarditis. Eur Heart J
29: 2073-2082
[Abstract][Full Text]
Matsumoto, Y., Park, I.-K., Kohyama, K.
(2007). B-Cell Epitope Spreading Is a Critical Step for the Switch from C-Protein-Induced Myocarditis to Dilated Cardiomyopathy. Am. J. Pathol.
170: 43-51
[Abstract][Full Text]
Magnani, J. W., Dec, G. W.
(2006). Myocarditis: Current Trends in Diagnosis and Treatment. Circulation
113: 876-890
[Full Text]
Gagliardi, M G., Bevilacqua, M, Bassano, C, Leonardi, B, Boldrini, R, Camassei, F D., Fierabracci, A, Ugazio, A G, Bottazzo, G F
(2004). Long term follow up of children with myocarditis treated by immunosuppression and of children with dilated cardiomyopathy. Heart
90: 1167-1171
[Abstract][Full Text]
Torre-Amione, G., Sestier, F., Radovancevic, B., Young, J.
(2004). Effects of a novel immune modulation therapy in patients with advanced chronic heart failure: Results of a randomized, controlled, phase II trial. J Am Coll Cardiol
44: 1181-1186
[Abstract][Full Text]
Matsumoto, Y., Tsukada, Y., Miyakoshi, A., Sakuma, H., Kohyama, K.
(2004). C Protein-Induced Myocarditis and Subsequent Dilated Cardiomyopathy: Rescue from Death and Prevention of Dilated Cardiomyopathy by Chemokine Receptor DNA Therapy. J. Immunol.
173: 3535-3541
[Abstract][Full Text]
Staudt, A., Staudt, Y., Dorr, M., Bohm, M., Knebel, F., Hummel, A., Wunderle, L., Tiburcy, M., Wernecke, K. D., Baumann, G., Felix, S. B.
(2004). Potential role of humoral immunity in cardiac dysfunction of patients suffering from dilated cardiomyopathy. J Am Coll Cardiol
44: 829-836
[Abstract][Full Text]
Hia, C P P, Yip, W C L, Tai, B C, Quek, S C
(2004). Immunosuppressive therapy in acute myocarditis: an 18 year systematic review. Arch. Dis. Child.
89: 580-584
[Abstract][Full Text]
Mason, J. W
(2003). Myocarditis and dilated cardiomyopathy: An inflammatory link. Cardiovasc Res
60: 5-10
[Abstract][Full Text]
Frustaci, A., Chimenti, C., Calabrese, F., Pieroni, M., Thiene, G., Maseri, A.
(2003). Immunosuppressive Therapy for Active Lymphocytic Myocarditis: Virological and Immunologic Profile of Responders Versus Nonresponders. Circulation
107: 857-863
[Abstract][Full Text]
Felix, S.B., Staudt, A., Baumann, G.
(2002). Immunoadsorption as a new therapeutic principle for treatment of dilated cardiomyopathy. Eur Heart J Suppl
4: I63-I68
[Abstract]
Frustaci, A., Pieroni, M., Chimenti, C.
(2002). Immunosuppressive therapy in inflammatory cardiomyopathy. Eur Heart J Suppl
4: I69-I72
[Abstract]
Kuhl, U., Pauschinger, M., Noutsias, M., Kapp, J.-F., Schultheiss, H.-P.
(2002). Diagnosis and treatment of patients with virus induced inflammatory cardiomyopathy. Eur Heart J Suppl
4: I73-I80
[Abstract]
Hjalmarson, A., Fu, M., Mobini, R.
(2002). Who are the enemies? Inflammation and autoimmune mechanisms. Eur Heart J Suppl
4: G27-G32
[Abstract]
Liu, P. P., Mason, J. W.
(2001). Advances in the Understanding of Myocarditis. Circulation
104: 1076-1082
[Full Text]
Parrillo, J. E.
(2001). Inflammatory Cardiomyopathy (Myocarditis) : Which Patients Should Be Treated With Anti-Inflammatory Therapy?. Circulation
104: 4-6
[Full Text]
Wojnicz, R., Nowalany-Kozielska, E., Wojciechowska, C., Glanowska, G., Wilczewski, P., Niklewski, T., Zembala, M., Polonski, L., Rozek, M. M., Wodniecki, J.
(2001). Randomized, Placebo-Controlled Study for Immunosuppressive Treatment of Inflammatory Dilated Cardiomyopathy : Two-Year Follow-Up Results. Circulation
104: 39-45
[Abstract][Full Text]
McNamara, D. M., Holubkov, R., Starling, R. C., Dec, G. W., Loh, E., Torre-Amione, G., Gass, A., Janosko, K., Tokarczyk, T., Kessler, P., Mann, D. L., Feldman, A. M.
(2001). Controlled Trial of Intravenous Immune Globulin in Recent-Onset Dilated Cardiomyopathy. Circulation
103: 2254-2259
[Abstract][Full Text]
Feldman, A. M., McNamara, D.
(2000). Myocarditis. NEJM
343: 1388-1398
[Full Text]
Bozkurt, B.
(2000). Activation of cytokines as a mechanism of disease progression in heart failure. Ann Rheum Dis
59: i90-93
[Full Text]
Hunt, S. A., Frazier, O.H.
(1998). Mechanical Circulatory Support and Cardiac Transplantation. Circulation
97: 2079-2090
[Full Text]
McNamara, D. M., Rosenblum, W. D., Janosko, K. M., Trost, M. K., Villaneuva, F. S., Demetris, A.J., Murali, S., Feldman, A. M.
(1997). Intravenous Immune Globulin in the Therapy of Myocarditis and Acute Cardiomyopathy. Circulation
95: 2476-2478
[Abstract][Full Text]
Cunnion, R. E., Parrillo, J. E., Maisch, B., Camerini, F., Schultheiss, H.-P., Cooper, L. T., Shabetai, R., Mason, J. W., O'Connell, J. B., McManus, B. M.
(1995). Immunosuppressive Therapy for Myocarditis. NEJM
333: 1713-1714
[Full Text]
Costanzo, M. R., Augustine, S., Bourge, R., Bristow, M., O'Connell, J. B., Driscoll, D., Rose, E.
(1995). Selection and Treatment of Candidates for Heart Transplantation : A Statement for Health Professionals From the Committee on Heart Failure and Cardiac Transplantation of the Council on Clinical Cardiology, American Heart Association. Circulation
92: 3593-3612
[Abstract][Full Text]
Dec, G. W., Fuster, V.
(1994). Idiopathic Dilated Cardiomyopathy. NEJM
331: 1564-1575
[Full Text]
Lange, L. G., Schreiner, G. F.
(1994). Immune Mechanisms of Cardiac Disease. NEJM
330: 1129-1135
[Full Text]
(1989). PREDNISONE IS OF LITTLE BENEFIT IN DILATED CARDIOMYOPATHY. JWatch General
1989: 4-4
[Full Text]
