Background: Inflammatory cardiomyopathy (infl-CMP) is characterized by increased cardiac inflammation in the absence of viruses, ischemia, valvular disease, or other apparent causes. Studies addressing the efficacy of immunosuppressive therapy in patients with infl-CMP are sparse. This study retrospectively investigates whether immunosuppressive agents on top of heart failure therapy according to current guidelines improves cardiac function and long-term outcome in patients with infl-CMP.

Methods and Results: Within the Innsbruck and Maastricht Cardiomyopathy Registry, a total of 209 patients fulfilled the criteria for infl-CMP using endomyocardial biopsy (≥14 infiltrating inflammatory cells/mm²). A total of 110 (53%) patients received immunosuppressive therapy and 99 (47%) did not. To correct for potential selection bias, 1:1 propensity score matching was used on all significant baseline parameters, resulting in a total of 90 patients per group. Baseline characteristics did not significantly differ between both patient groups, reflecting optimal propensity score matching. After a median follow-up of 31 (15–47) months, immunosuppressive therapy resulted in an improved long-term outcome (eg, heart transplantation–free survival) as compared with standard heart failure therapy alone (Log-rank P=0.043; hazard ratio, 0.34 [95% CI, 0.17–0.92]) and in a significant larger increase of left ventricular ejection fraction after a mean of 12 months follow-up, as compared with patients receiving standard heart failure treatment only (12.2% versus 7.3%, respectively; P=0.036).

Conclusions: To conclude, this study suggests that immunosuppressive therapy in infl-CMP patients results in an improved heart transplantation–free survival as compared with standard heart failure therapy alone, underscoring the urgent need for a large prospective multicenter trial.

背景：炎性心肌病（infl-CMP）的特征是在没有病毒，缺血，瓣膜疾病或其他明显原因的情况下，心脏炎症增加。关于针对infl-CMP患者的免疫抑制疗法功效的研究很少。这项研究回顾性研究了根据当前指南在心力衰竭治疗之上使用免疫抑制剂是否可以改善infl-CMP患者的心脏功能和长期预后。

方法和结果：在因斯布鲁克和马斯特里赫特心肌病登记处内，共有209名患者通过心内膜活检符合了infl-CMP的标准（≥14浸润性炎症细胞/ mm ²）。共有110名患者（53％）接受了免疫抑制治疗，而99名患者（47％）没有接受免疫抑制治疗。为了纠正潜在的选择偏见，对所有重要的基线参数使用1：1倾向评分匹配，每组总共90例患者。两组患者之间的基线特征无显着差异，反映出最佳倾向评分匹配。与仅标准心力衰竭治疗相比，中位随访31（15-47）个月后，免疫抑制治疗可改善长期预后（例如，无心脏移植生存）（Log-rank P= 0.043; 风险比为0.34 [95％CI，0.17-0.92]），与仅接受标准心力衰竭治疗的患者相比，平均随访12个月后左心室射血分数显着增加（12.2％比7.3） ％；P＝ 0.036）。

结论：结论是，这项研究表明，与单独的标准心力衰竭治疗相比，infl-CMP患者的免疫抑制治疗可改善无心脏移植的生存期，从而强调了对大型前瞻性多中心试验的迫切需求。