Author + information
- Received July 7, 2003
- Revision received December 19, 2003
- Accepted January 20, 2004
- Published online September 15, 2004.
- Mototsugu Nishii, MD* (, )
- Takayuki Inomata, PhD, MD,
- Hitoshi Takehana, PhD, MD,
- Ichiro Takeuchi, MD,
- Hironari Nakano, MD,
- Toshimi Koitabashi, MD,
- Jun-ichi Nakahata, MD,
- Naoyoshi Aoyama, PhD, MD and
- Tohru Izumi, PhD, MD
- ↵*Reprint requests and correspondence:
Dr. Mototsugu Nishii, Department of Internal Medicine and Cardiology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, 228-8555 Kanagawa, Japan
Objectives We assessed the significance of serum cytokine levels in patients with fulminant myocarditis.
Background Although many investigations have demonstrated the crucial role of cytokines in the development of myocarditis, it remains uncertain whether serum levels of cytokines enable one to predict the prognosis of human myocarditis, especially concerning cardiogenic shock (CS) requiring a mechanical cardiopulmonary support system (MCSS).
Methods We studied 22 consecutive patients with fulminant myocarditis and compared them with 15 patients with acute myocardial infarction (AMI) requiring MCSS. The patients with myocarditis were classified into three groups: eight patients with CS requiring MCSS on admission (group 1); six patients who unexpectedly lapsed into CS requiring MCSS more than two days after catecholamine had been initiated (group 2); and eight patients without MCSS (group 3). Furthermore, 14 patients with myocarditis requiring MCSS were divided into a fatal group (n = 5) and a survival group (n = 9). Biochemical markers, including serum cytokine levels and hemodynamic variables on admission, were analyzed.
Results Serum levels of interleukin (IL)-10 and tumor necrosis factor-alpha, but not other cytokines, were significantly higher in myocarditis than in AMI. Only serum levels of IL-10 were significantly higher in group 1 and 2 than in group 3 (49.1 ± 37.5/20.7 ± 17.6 pg/ml vs. 2.4 ± 1.1 pg/ml; p = 0.0008/0.0012). Serum IL-10 levels were also significantly higher in the fatal group than in the survival group with myocarditis (74.0 ± 27.0 pg/ml vs. 16.4 ± 8.8 pg/ml; p = 0.003).
Conclusions Serum IL-10 levels on admission enabled one to predict subsequent CS requiring MCSS and mortality of fulminant myocarditis patients.
Supported in part by a grant-in-aid for scientific research from the Postgraduate Research Project at Kitasato University, a Kitasato University Research Grant for Young Researchers, and the Parents' Association Grant of Kitasato University School of Medicine, and also by a grant for scientific research from the Ministry of Education, Science, and Culture of Japan (No. 20311954).
- Received July 7, 2003.
- Revision received December 19, 2003.
- Accepted January 20, 2004.
- American College of Cardiology Foundation