Article Impact Level: HIGH Data Quality: STRONG Summary of European Heart Journal, 43(36), 3463–3473. https://doi.org/10.1093/eurheartj/ehac348 European Heart Journal, 43(36), 3474–3476. https://doi.org/10.1093/eurheartj/ehac412 Dr. Cristina Chimenti et al
Points
- Patients with virus-negative inflammatory cardiomyopathy who took prednisone and azathioprine for six months as part of the TIMIC immunosuppressive treatment showed better left ventricular function at a 20-year follow-up relative to propensity-matched controls.
- This investigation raises the possibility of protracted suppressive medication’s effectiveness by suggesting that myocardial inflammation persists and does not get better with therapeutic cardiovascular disease care.
Summary
The investigation’s objectives were to assess the prolonged prognoses of participants in the initial TIMIC test and the responsiveness of recurring myocarditis to a fresh immunosuppression cycle according to the TIMIC regimen.
The TIMIC study design was based on a randomized, placebo-controlled, and double-blind experiment. This investigation was based on providing immunosuppressive therapy in the form of medications like prednisolone for four weeks in 43 participants and azathioprine for six months in 42 participants.
The main result, a combination of cardiac mortality rates and transplants, was around 7.1% for the TIMIC group compared to the matched controls, which came up to around 4%. Similarly, the secondary outcomes in implantable cardioverter defibrillator implantation were around 10%in the TIMIC trial and 42% in the matched trial. Relapse of myocarditis was in a respective ratio of 5% in the TIMIC trial and around 8% in the score-matched experiment.
All trial participants in the placebo group had continued or increased cardiac damage at six months and were all given the immunosuppressive treatment for about six months. Its inclusion criterion was based on hospitalization for cardiovascular disorder with a histologically confirmed diagnosis of virus-negative chronic inflammatory cardiomyopathy without any need for immunosuppressive drugs. The average age of participants in the study was 44, and the average left ventricular ejection fraction was 26%. Meanwhile, those participants who refused to participate in the TIMIC trial were excluded.
According to the investigation’s findings, prednisone plus azathioprine treatment for six months reduced the risk of cardiac mortality or cardiac transplant in patients with virus-negative inflammatory cardiomyopathy relative to likelihood score-matched counterparts.
Because all participants in the original TIMIC study who were allocated to the placebo arm were later given immunosuppressive treatment after the experiment finished, comparison to matched controls allowed a more accurate comparison to individuals who did not get the medication.
Links to the articles: https://academic.oup.com/eurheartj/article/43/36/3463/6643511 https://academic.oup.com/eurheartj/article-abstract/43/36/3474/6653708
References Chimenti, C., Russo, M. A., & Frustaci, A. (2022). Immunosuppressive therapy in virus-negative inflammatory cardiomyopathy: 20-year follow-up of the TIMIC trial. European Heart Journal, 43(36), 3463–3473. https://doi.org/10.1093/eurheartj/ehac348 Schultheiss, H. P., & Escher, F. (2022). Advanced diagnostics in inflammatory cardiomyopathy for personalized therapeutic decision-making. European Heart Journal, 43(36), 3474–3476. https://doi.org/10.1093/eurheartj/ehac412
