Predictors of relapse, death or heart transplantation in myocarditis before the introduction of immunosuppression: negative prognostic impact of female gender, fulminant onset, lower ejection fraction and serum autoantibodies

Baritussio, Anna; Schiavo, Alessandro; Basso, Cristina; Giordani, Andrea Silvio; Cheng, Chun‐Yan; Pontara, Elena; Cattini, Maria Grazia; Bison, Elisa; Gallo, Nicoletta; Gaspari, Monica De; Carturan, Elisa; Thiene, Gaetano; Tarantini, Giuseppe; Plebani, Mario; Rizzo, Stefania; Gregori, Darío; Iliceto, Sabino; Marcolongo, R

doi:10.1002/ejhf.2496

Cited by 33 publications

(41 citation statements)

References 46 publications

(248 reference statements)

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“…Another study showed that female sex was associated with worse outcomes in patients with myocarditis. 6 In our study, the proportion of female patients was higher in FMP than in non-FMP, but sex was not associated with mortality or HTx in FMP. Histologic diagnosis is highly recommended for patients with FMP because EMB is the only method that allows the diagnosis and pathogenic clarification of myocarditis.…”

Section: Discussioncontrasting

confidence: 50%

Features and Outcomes of Histologically Proven Myocarditis With Fulminant Presentation

et al. 2022

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BACKGROUND: Fulminant myocarditis presentation (FMP) is a rare and severe presentation of myocarditis. The natural history of FMP and its clinical features associated with poor outcomes are incompletely understood because there is a lack of generalizable evidence. METHODS: This multicenter retrospective cohort study included patients hospitalized with histologically proven myocarditis who underwent catecholamine or mechanical support from 235 cardiovascular training hospitals across Japan between April 2012 and March 2017. Clinical features and the prognostic predictors of death or heart transplantation within 90 days on the basis of clinical and pathologic findings were determined using the Kaplan-Meier method, log-rank test, and Cox regression analysis. RESULTS: This study included 344 patients with histologically proven FMP (median age, 54 years; 40% female). The median follow-up was 600 days (interquartile range, 36 to 1599 days) and the cumulative risk of death or heart transplantation at 90 days was 29% (n=98). Results from multivariable Cox regression analysis showed that older age, nonsinus rhythm, low left ventricular wall motion (<40%) on admission, and ventricular tachycardia or fibrillation on admission day were associated with worse 90-day survival. Severe histologic damage (damaged cardiomyocytes comprising ≥50% of the total cardiomyocytes) was associated with a worse 90-day prognosis in patients with lymphocytic myocarditis. CONCLUSIONS: The results from analyses of data from this multicenter registry demonstrated that patients with FMP are at a higher risk of death or heart transplantation in real-world settings. These observations inform which clinical and pathologic findings may be useful for prognostication in FMP. REGISTRATION: URL: https://www.umin.ac.jp/ctr ; Unique identifier: UMIN000039763.

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Section: Discussioncontrasting

confidence: 50%

Features and Outcomes of Histologically Proven Myocarditis With Fulminant Presentation

et al. 2022

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“…Survival free from death or heart transplantation at 10 years was 83% and was lower in biopsy‐proven versus clinically suspected myocarditis (76% vs. 94%, p < 0.001). Female gender, fulminant presentation, anti‐nuclear antibodies and lower LVEF were predictors of death or heart transplantation 24 …”

Section: Discussionmentioning

confidence: 99%

“…Female gender, fulminant presentation, anti-nuclear antibodies and lower LVEF were predictors of death or heart transplantation. 24…”

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confidence: 99%

June 2022 at a glance: prevention, outcomes and treatment

Tomasoni

Adamo

Metra

2022

European J of Heart Fail

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Myocardial infarction (MI) is a major cause of heart failure (HF). [1][2][3] Rastogi et al. 4 showed different characteristics associated with the progression to HF in patients with or without a history of MI in the HOMAGE (Heart 'OMics' in AGEing) cohort. Older age, male sex and higher heart rate were associated with an increased risk of HF in all subjects, whereas lower renal function had a stronger association with HF in patients with a history of MI, and higher body mass index, hypertension and blood glucose were significant only in patients without a history of MI. These data were confirmed in the UK Biobank (validation cohort). 4 Chronic kidney disease (CKD) is a major risk factor for HF. 2,5 Janus et al. 6 investigated the usefulness of biomarkers to predict the risk of HF in 3182 patients with CKD in the Chronic Renal Insufficiency Cohort (CRIC). Four biomarkers -B-type natriuretic peptide, fibroblast growth factor-23, fibrinogen and high-sensitivity troponin T -were associated with incident HF after adjustment for other risk factors and their inclusion allowed a better risk stratification for incident HF. Acute myocarditisOutcomes of acute myocarditis are not clearly defined. 3,22,23 A total of 466 consecutive patients, with clinically suspected or biopsy-proven myocarditis, were enrolled in a single centre prospective study from 1992 to 2012. Survival free from death or heart transplantation at 10 years was 83% and was lower in biopsy-proven versus clinically suspected myocarditis (76% vs. 94%, p < 0.001). Female gender, fulminant presentation, anti-nuclear antibodies and lower LVEF were predictors of death or heart transplantation. 24

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“…Clinical myocarditis phenotypes have established prognostic value. For example, hemodynamic compromise with cardiogenic shock, the presence of ventricular arrhythmias, high-grade heart block, female sex and lower left and right ventricular systolic function increase the risk of subsequent death or heart transplantation [ 97 , 98 ]. However, the features on heart biopsy histology and cardiovascular magnetic resonance imaging (MRI) that guide therapy are limited to a few uncommon conditions, such as giant cell or eosinophilic myocarditis.…”

Section: Clinical Presentationmentioning

confidence: 99%

Meeting the Challenges of Myocarditis: New Opportunities for Prevention, Detection, and Intervention—A Report from the 2021 National Heart, Lung, and Blood Institute Workshop

Čiháková

Shi

Adhikari

et al. 2022

JCM

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The National Heart, Lung, and Blood Institute (NHLBI) convened a workshop of international experts to discuss new research opportunities for the prevention, detection, and intervention of myocarditis in May 2021. These experts reviewed the current state of science and identified key gaps and opportunities in basic, diagnostic, translational, and therapeutic frontiers to guide future research in myocarditis. In addition to addressing community-acquired myocarditis, the workshop also focused on emerging causes of myocarditis including immune checkpoint inhibitors and SARS-CoV-2 related myocardial injuries and considered the use of systems biology and artificial intelligence methodologies to define workflows to identify novel mechanisms of disease and new therapeutic targets. A new priority is the investigation of the relationship between social determinants of health (SDoH), including race and economic status, and inflammatory response and outcomes in myocarditis. The result is a proposal for the reclassification of myocarditis that integrates the latest knowledge of immunological pathogenesis to refine estimates of prognosis and target pathway-specific treatments.

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Predictors of relapse, death or heart transplantation in myocarditis before the introduction of immunosuppression: negative prognostic impact of female gender, fulminant onset, lower ejection fraction and serum autoantibodies

Abstract: Outcome predictors in myocarditis are not well defined; we aimed at identifying predictors of death, heart transplantation (HTx) and relapse before the introduction of immunosuppression.

Cited by 33 publications

References 46 publications

Features and Outcomes of Histologically Proven Myocarditis With Fulminant Presentation

Features and Outcomes of Histologically Proven Myocarditis With Fulminant Presentation

June 2022 at a glance: prevention, outcomes and treatment

Meeting the Challenges of Myocarditis: New Opportunities for Prevention, Detection, and Intervention—A Report from the 2021 National Heart, Lung, and Blood Institute Workshop

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