A Machine-Learning Model for the Prognostic Role of C-Reactive Protein in Myocarditis

Abstract

Aims: The role of inflammation markers in myocarditis is unclear. We assessed the diagnostic and prognostic correlates of C-reactive protein (CRP) at diagnosis in patients with myocarditis. Methods and results: We retrospectively enrolled patients with clinically suspected (CS) or biopsy-proven (BP) myocarditis, with available CRP at diagnosis. Clinical, laboratory and imaging data were collected at diagnosis and at follow-up visits. To evaluate predictors of death/heart transplant (Htx), a machine-learning approach based on random forest for survival data was employed. We included 409 patients (74% males, aged 37 ± 15, median follow-up 2.9 years). Abnormal CRP was reported in 288 patients, mainly with CS myocarditis (p < 0.001), recent viral infection, shorter symptoms duration (p = 0.001), chest pain (p < 0.001), better functional class at diagnosis (p = 0.018) and higher troponin I values (p < 0.001). Death/Htx was reported in 13 patients, of whom 10 had BP myocarditis (overall 10-year survival 94%). Survival rates did not differ according to CRP levels (p = 0.23). The strongest survival predictor was LVEF, followed by anti-nuclear auto-antibodies (ANA) and BP status. Conclusions: Raised CRP at diagnosis identifies patients with CS myocarditis and less severe clinical features, but does not contribute to predicting survival. Main death/Htx predictors are reduced LVEF, BP diagnosis and positive ANA.

The Role of the Immune System in Pathobiology and Therapy of Myocarditis: A Review

“…To date, no definitive evidence of biopsy-proven myocarditis caused by SARS-CoV-2 infection or vaccination has been found. Conversely, a study demonstrated that SARS-CoV-2 vaccination is safe for patients with prior myocarditis; additionally, this study showed an absence of increased risk of myocarditis relapse after SARS-CoV-2 infection in the same patients' population [21].…”

“…Presence of circulating heart-specific autoantibodies in patients with inflammatory cardiomyopathy and their relatives. Caforio et al, 2007 [24] Mestroni et al, 1999 [25] Baritussio et al, 2022 [26] Animal models of experimentally induced inflammatory cardiomyopathy, with or without a DCM phenotype, after immunization with specific auto-antigen(s). Li et al, 2006 [27] Response to immunosuppressive or immunomodulant therapy in patients with virus-negative inflammatory cardiomyopathy.…”

C-Reactive Protein: Pathophysiology, Diagnosis, False Test Results and a Novel Diagnostic Algorithm for Clinicians

“…A normal hsCRP is rare even 2 days after the event, whereas Loeffler endocarditis has also shown elevated CRP levels [ 244 , 245 ]. CRP has been noted for its prognostic role in lymphocytic, eosinophilic, autoimmune, and viral myocarditis [ 246 , 247 ].…”

“…Endocarditis, myocarditis, and pericarditis resulting from various etiologies were previously discussed [ 3 , 240 , 241 , 242 , 243 , 244 , 245 , 246 , 247 ]. A CRP of more than 720 mg/L can predict high-risk individuals with a high in-hospital mortality rate due to infective endocarditis [ 893 ].…”