Long-Term Prognosis of Suspected Myocarditis and Cardiomyopathy Associated with Viral Infection of the Myocardial Tissue: A Meta-Analysis of Cohort Studies

Abstract

Aim. Myocarditis and cardiomyopathy impose a substantial economic burden on society. Many studies have examined the effects of various predictors on the prognosis of these diseases, such as the left ventricular systolic function, the New York Heart Association glomerular filtration rate, the QT interval, and the presence of viruses. In the present study, we conducted a meta-analysis of cohort studies to investigate the significance of the presence of viruses in the myocardial tissue on the prognosis of these diseases. Methods. The Embase, PubMed, and Cochrane library databases were searched for relevant literature that had been published between January 1, 1964 and August 14, 2018. The inclusion criteria were patients over 18 years of age, suspected myocarditis or dilated cardiomyopathy, accepted myocardial biopsy, and the detection of virus in the myocardial tissue. Results. In total, 10 studies met the inclusion criteria. These studies included 1006 patients with suspected myocarditis or idiopathic heart disease for whom the primary endpoint was all-cause death, heart transplant, or re-hospitalization due to fatal arrhythmia and heart failure. There was no significant difference in the prognosis of virus-positive and virus-negative patients with myocarditis or dilated cardiomyopathy confirmed by endomyocardial biopsy (EMB) [hazard ratio (HR) = 1.40, 95% confidence interval (CI) = 0.93–2.12, P=0.11]. However, virus-negative patients had a better prognosis following nonspecific treatment (HR = 1.40, 95% CI = 1.06–1.86, P=0.02) and right ventricular biopsy (HR = 2.08, 95% CI = 1.07–4.04, P=0.03). Conclusions. The presence of a virus did not worsen the long-term prognosis of patients with suspected myocarditis or dilated cardiomyopathy. However, virus-positive patients who did not undergo specific treatment or who underwent right ventricular biopsy did have a worse prognosis. Thus, the early diagnosis of the presence of viral infection in the myocardium will improve the prognosis of patients.

Myocarditis and inflammatory cardiomyopathy in 2021 – an update

“…The role of viral infection remains controversial. What is more, recently published metaanalysis of 10 studies (1006 patients with myocarditis or DCM) showed no significant difference in the prognosis of virus-positive and virus-negative patients [70]. However, in the setting of infective myocarditis, a targeted anti-viral therapy may be used, both in acute and chronic myocarditis.…”

Cardiomyopathies in China: A 2018–2019 state‐of‐the‐art review

“…However, histological examination, immunohistochemistry, and microbial genome and gene expression profiling are still valuable for diagnosis, follow-up, and prognosis. 30 …”

Evaluating the relationship between myocarditis and mRNA vaccination

“…It is important to note that the long-term cardiac implications of acute myocardial injury, especially when incurred at a young age, are not well known. A meta-analysis of cohort studies of suspected myocarditis in the presence of both viral infection and virus-negative patients found no significant differences in prognosis in terms of all-cause death, heart transplant, or re-hospitalization due to fatal arrhythmia and heart failure [ 28 ]. Observational studies assessing myocardial injury following COVID-19 infections found that persistent inflammation and regional fibrosis are common findings in patients recovered from viral myocarditis, and is associated with adverse outcomes [ 29–34 ].…”

“…Despite the growing evidence for incomplete recovery from post-viral autoimmune dysfunction [ 1 , 28 , 36–39 ], the long-term sequelae of vaccine-driven myocarditis are less clear [ 14 , 26 , 40 , 41 ]. One study using large cohort data demonstrated that viral infection is associated with a much greater risk of myocarditis, as compared to vaccine-induced myocarditis [ 42 ].…”