Long-Term Evolution and Prognostic Stratification of Biopsy-Proven Active Myocarditis

Abstract

Background-Active myocarditis is characterized by large heterogeneity of clinical presentation and evolution. This study describes the characteristics and the long-term evolution of a large sample of patients with biopsy-proven active myocarditis, looking for accessible and valid early predictors of long-term prognosis. Methods and Results-From 1981 to 2009, 82 patients with biopsy-proven active myocarditis were consecutively enrolled and followed-up for 147±107 months. All patients underwent clinical and echocardiographic evaluation at baseline and at 6 months. At this time, improvement/normality of left ventricular ejection fraction (LVEF), defined as a LVEF increase > 20 percentage points or presence of LVEF≥50%, was assessed. At baseline, left ventricular dysfunction (LVEF<50%) and left atrium enlargement were independently associated with long-term heart transplantation-free survival, regardless of the clinical pattern of disease onset. At 6 months, improvement/normality of LVEF was observed in 53% of patients. Persistence of New York Heart Association III to IV classes, left atrium enlargement, and improvement/normality of LVEF at 6 months emerged as independent predictors of long-term outcome. Notably, the short-term reevaluation showed a significant incremental prognostic value in comparison with the baseline evaluation (baseline model versus 6 months model: area under the curve 0.79 versus 0.90, P=0.03). Conclusions-Baseline left ventricular function is a marker for prognosis regardless of the clinical pattern of disease onset,and its reassessment at 6 months appears useful for assessing longer-term outcome.

Survival and Left Ventricular Function Changes in Fulminant Versus Nonfulminant Acute Myocarditis

“…The discrepancies with previously published reports can be explained by a number of reasons: low number of FM cases (≤15) in prior studies 7,8,11,13 that may have resulted in inadequate statistical power, a longer time frame between symptom onset and study entry that could have contributed to a selection bias (ie, exclusion of patients with the most aggressive acute course), and different entry criteria. 11,12 The present report includes a larger cohort of consecutive patients admitted at 2 centers who were diagnosed with acute myocarditis on the basis of clinical, instrumental, laboratory, CMR, or pathology criteria.…”

“…Definite clinical criteria for predicting outcome are not clear and may differ according to diagnostic workup and the timing of diagnosis. 8,9 Previous studies, in relatively small cohorts of patients with biopsy-proven myocarditis, have asserted the rather counterintuitive finding that patients presenting with fulminant myocarditis (FM 10 ; ie, distinct heart failure [HF] symptoms and hemodynamic compromise requiring inotropes and/or mechanical circulatory support [MCS]) may have a better prognosis than patients with the nonfulminant (NFM) form (ie, mild cardiac symptoms and no hemodynamic compromise). 11,12 In the majority of these previous studies, patients were enrolled retrospectively, after the presumed acute phase, on the basis of evidence of chronic left ventricular (LV) dysfunction.…”

Cardiac Magnetic Resonance Imaging in Myocarditis Reveals Persistent Disease Activity Despite Normalization of Cardiac Enzymes and Inflammatory Parameters at 3-Month Follow-Up

“…[1][2][3][4][5] Clinical presentation may range from mild symptoms to severe heart failure and ventricular arrhythmias. 6,7 Myocarditis has been reported in up to 25% of young adults presenting with sudden death. [8][9][10][11][12] As of today, there is a major unmet need to accurately diagnose patients with myocarditis and to identify individuals at highest risk for adverse cardiovascular events.…”

Analysis of the Reasons of Later Diagnostics of Myocarditis

“…зарубежные исследователи выделяются только три основных варианта дебюта заболевания: инфарктоподобный (27−31%), вариант с развитием жизнеопасных нарушений ритма и проводимости (18%), и с клиникой Сн (31−69%). два последних варианта, как правило, ассоциированы с неблагоприятным для больного прогнозом [6]. По данным отечественных публикаций первым проявлением миокардита может быть одышка -68,6%, сердцебиение 32,8%, повышение температуры 29,8%, кардиалгия 22,3%, перебои в работе сердца 16,4 %, головокружение 2,9%, синкопальные состояния 1,5% [7].…”