Clinical profile of biopsy proven idiopathic myocarditis

Ramamurthy, S; Kk, Talwar; Goswami, Kewal C.; Shrivastava, Savitri; Chopra, Prem; Broor, Shobha; Malhotra, Arun

doi:10.1016/0167-5273(93)90119-2

Cited by 34 publications

(11 citation statements)

References 13 publications

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“…[20] In addition, the authors of another study found that women with myocarditis were more likely to develop ventricular arrhythmias than men with myocarditis ( OR = 2.43, 95% CI : 1.12–5.27) and that women possessed longer QT intervals, as demonstrated by electrocardiography, due to decreases in the expression levels of some pivotal proteins. [21] Moreover, myocarditis prolongs ventricular repolarization times in approximately 70% of patients. The combination of these changes, the QT interval fluctuations caused by the menstrual cycle in women,[22] and the decreases in action potential durations induced by testosterone production in men[23] are responsible for the more frequent occurrences of ventricular arrhythmias in women than in men.…”

Section: Discussionmentioning

confidence: 99%

A Risk Prediction Model for In-hospital Mortality in Patients with Suspected Myocarditis

Zhao

Gao

et al. 2017

Chinese Medical Journal

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Background:Myocarditis is an inflammatory disease of the myocardium that may lead to cardiac death in some patients. However, little is known about the predictors of in-hospital mortality in patients with suspected myocarditis. Thus, the aim of this study was to identify the independent risk factors for in-hospital mortality in patients with suspected myocarditis by establishing a risk prediction model.Methods:A retrospective study was performed to analyze the clinical medical records of 403 consecutive patients with suspected myocarditis who were admitted to Ningbo First Hospital between January 2003 and December 2013. A total of 238 males (59%) and 165 females (41%) were enrolled in this study. We divided the above patients into two subgroups (survival and nonsurvival), according to their clinical in-hospital outcomes. To maximize the effectiveness of the prediction model, we first identified the potential risk factors for in-hospital mortality among patients with suspected myocarditis, based on data pertaining to previously established risk factors and basic patient characteristics. We subsequently established a regression model for predicting in-hospital mortality using univariate and multivariate logistic regression analyses. Finally, we identified the independent risk factors for in-hospital mortality using our risk prediction model.Results:The following prediction model for in-hospital mortality in patients with suspected myocarditis, including creatinine clearance rate (Ccr), age, ventricular tachycardia (VT), New York Heart Association (NYHA) classification, gender and cardiac troponin T (cTnT), was established in the study: P = ea/(1 + ea) (where e is the exponential function, P is the probability of in-hospital death, and a = −7.34 + 2.99 × [Ccr <60 ml/min = 1, Ccr ≥60 ml/min = 0] + 2.01 × [age ≥50 years = 1, age <50 years = 0] + 1.93 × [VT = 1, no VT = 0] + 1.39 × [NYHA ≥3 = 1, NYHA <3 = 0] + 1.25 × [male = 1, female = 0] + 1.13 × [cTnT ≥50 μg/L = 1, cTnT <50 μg/L = 0]). The area under the receiver operating characteristic curve was 0.96 (standard error = 0.015, 95% confidence interval [CI]: 0.93-0.99). The model demonstrated that a Ccr <60 ml/min (odds ratio [OR] = 19.94, 95% CI: 5.66–70.26), an age ≥50 years (OR = 7.43, 95% CI: 2.18–25.34), VT (OR = 6.89, 95% CI: 1.86–25.44), a NYHA classification ≥3 (OR = 4.03, 95% CI: 1.13–14.32), male gender (OR = 3.48, 95% CI: 0.99–12.20), and a cTnT level ≥50 μg/L (OR = 3.10, 95% CI: 0.91–10.62) were the independent risk factors for in-hospital mortality.Conclusions:A Ccr <60 ml/min, an age ≥50 years, VT, an NYHA classification ≥3, male gender, and a cTnT level ≥50 μg/L were the independent risk factors resulting from the prediction model for in-hospital mortality in patients with suspected myocarditis. In addition, sufficient life support during the early stage of the disease might improve the prognoses of patients with suspected myocarditis with multiple risk factors for in-hospital mortality.

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Section: Discussionmentioning

confidence: 99%

A Risk Prediction Model for In-hospital Mortality in Patients with Suspected Myocarditis

Zhao

Gao

et al. 2017

Chinese Medical Journal

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“…Possible explanation for this is the prolonged ventricular repolarisation which is related to occurrence of ventricular arrhythmias in myocarditis 24. Women are known to have longer baseline QT intervals than men, and prolonged repolarisation is a common feature in myocarditis, present in up to 70% of patients 25. The reduced expression of K-channel subunits and connexin43 in addition to fluctuation of QT interval during menstrual cycle are implicated as causes for prolonged repolarisation and arrhythmia vulnerability in women26 while testosterone is likely to protect men from arrhythmias by shortening action potential 27…”

Section: Discussionmentioning

confidence: 99%

The effects of gender and age on occurrence of clinically suspected myocarditis in adulthood

Kytö

Sipilä

Rautava

2013

Heart

106

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“…Myocardial repolarization is assessed by different indices including QT, QTc, QT dispersion, TpTe interval, TpTe/Qt ratio, and TpTe/QTc, which are accepted as indicators of QT dispersion, corrected QT dispersion, and transmural repolarization dispersion in various studies (7,17). Prolonged QTc was shown to be the most common ECG finding in a study that examined 20 patients with myocarditis and suffering serious complications (lifethreatening arrhythmias) (18). Similarly, when Amoozgar et al compared patients with Kawasaki disease and a control group, they took QT interval as an index of transmural dispersion of repolarization and found that both QT and QTc interval were prolonged in the patient group (19).…”

Section: Discussionmentioning

confidence: 99%

Assessment of repolarization abnormalities in baseline electrocardiograms of patients with myocarditis

Güneş¹,

Güler²,

Güler³

et al. 2017

Turk J Med Sci

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Background/aim: Myocarditis in the acute phase usually presents with sinus tachycardia but many other arrhythmias might be seen as well. In this study we aimed to investigate repolarization abnormalities in baseline ECG of patients with myocarditis for the first time.Materials and methods: Thirty patients diagnosed with myocarditis and 25 healthy age-matched controls were included. Two different cardiologists measured corrected QT (QTc), QT dispersion (QTd), QT peak (QTp), T wave peak to T wave end (TpTe), TpTe/QT ratio, and TpTe/QTc ratio in 12-lead ECG.Results: When compared with the control group, QTp (P: 0.021), QT (P: 0.003), TpTe (P < 0.001), TpTe/QTc ratio (P < 0.001), and TpTe/ QT ratio (P: 0.005) were significantly higher in patients with myocarditis. A comparison of receiver operating characteristic (ROC) curves was conducted using the Hanley and McNeil method. The area under the curve (AUC) of the electrocardiographic characteristics QT (AUC: 0.736; 95% CI [0.600-0.846]), QTP (AUC: 0.680; 95% CI [0.540-0.799]), and TpTe (AUC: 0.771; 95% CI [0.638-873]) and TpTe/QTc (AUC: 0.774; 95% CI [0.641-0.876]) and TpTe/QT (AUC: 0.726; 95% CI [0.589-0.838]) in myocarditis were not significantly different from each other but all of them were different from 0.5. Conclusion:Baseline ECGs of patients with myocarditis were associated with repolarization abnormalities. These novel findings may be one of the reasons underlying arrhythmic events in patients with myocarditis.

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Clinical profile of biopsy proven idiopathic myocarditis

Cited by 34 publications

References 13 publications

A Risk Prediction Model for In-hospital Mortality in Patients with Suspected Myocarditis

A Risk Prediction Model for In-hospital Mortality in Patients with Suspected Myocarditis

The effects of gender and age on occurrence of clinically suspected myocarditis in adulthood

Assessment of repolarization abnormalities in baseline electrocardiograms of patients with myocarditis

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