Enrico Ammirati, Manlio Cipriani1, Claudio Moro2, Claudia Raineri3, Daniela Pini4, Paola Sormani1, Riccardo Mantovani4, Marisa Varrenti1, Patrizia Pedrotti1, Cristina Conca5, Antonio Mafrici5, Aurelia Grosu6, Daniele Briguglia7, Silvia Guglielmetto8, Giovanni B Perego8, Stefania Colombo9, Salvatore I Caico9, Cristina Giannattasio1,10, Alberto Maestroni11, Valentina Carubelli12, Marco Metra12, Carlo Lombardi12, Jeness Campodonico13, Piergiuseppe Agostoni13,14, Giovanni Peretto15, Laura Scelsi3, Annalisa Turco3, Giuseppe Di Tano16, Carlo Campana17, Armando Belloni18, Fabrizio Morandi19, Andrea Mortara20, Antonio Cirò21, Michele Senni6, Antonello Gavazzi22, Maria Frigerio1, Fabrizio Oliva1, Paolo G Camici15. 1. De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy (E.C., M.C., P.S., M.V., P.P., C.G., M.F., F.O.). 2. Desio Hospital, Italy (C.M.). 3. Fondazione Istituto di Ricerca e Cura a Carattere Scientifico Policlinico San Matteo and the University of Pavia, Italy (C.R., L.S., A.T.). 4. Humanitas Clinical and Research Center, Rozzano, Italy (D.P., R.M.). 5. San Carlo Borromeo Hospital, Milan, Italy (C. Conca, A. Mafrici). 6. Papa Giovanni XXIII Hospital, Bergamo, Italy (A. Grosu, M.S.). 7. Mater Domini Humanitas Hospital, Castellanza, Italy (D.B.). 8. San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (S.G., G.B.P.). 9. Azienda Socio Sanitaria Territoriale Valle Olona, Gallarate Hospital, Italy (S.C., S.I.C.). 10. University of Milano-Bicocca, Milan, Italy (C.G.). 11. Busto Arsizio Hospital, Italy (A. Maestroni). 12. Spedali Civili, University of Brescia, Italy (V.C., M.M., C.L.). 13. Monzino Center, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy (J.C., P.A.). 14. Department of Clinical Sciences and Community Health, University of Milan, Italy (P.A.). 15. Vita Salute University and San Raffaele Hospital, Milan, Italy (G.P., P.G.C.). 16. Azienda Socio Sanitaria Territoriale Cremona, Cremona Hospital, Italy (G.D.T.). 17. Sant'Anna Hospital, Como, Italy (C. Campana). 18. Sacco Hospital, Milan, Italy (A.B.). 19. Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy (F.M.). 20. Policlinico di Monza, Italy (A. Mortara). 21. San Gerardo Hospital, Monza, Italy (A.C.). 22. Fondazione per la Ricerca dell'Ospedale di Bergamo Research Foundation Ospedale Papa Giovanni XXIII, Bergamo, Italy (A. Gavazzi).
Abstract
BACKGROUND: There is controversy about the outcome of patients with acute myocarditis (AM), and data are lacking on how patients admitted with suspected AM are managed. We report characteristics, in-hospital management, and long-term outcome of patients with AM based on a retrospective multicenter registry from 19 Italian hospitals. METHODS: A total of 684 patients with suspected AM and recent onset of symptoms (<30 days) were screened between May 2001 and February 2017. Patients >70 years of age and those >50 years of age without coronary angiography were excluded. The final study population comprised 443 patients (median age, 34 years; 19.4% female) with AM diagnosed by either endomyocardial biopsy or increased troponin plus edema and late gadolinium enhancement at cardiac magnetic resonance. RESULTS: At presentation, 118 patients (26.6%) had left ventricular ejection fraction <50%, sustained ventricular arrhythmias, or a low cardiac output syndrome, whereas 325 (73.4%) had no such complications. Endomyocardial biopsy was performed in 56 of 443 (12.6%), and a baseline cardiac magnetic resonance was performed in 415 of 443 (93.7%). Cardiac mortality plus heart transplantation rates at 1 and 5 years were 3.0% and 4.1%. Cardiac mortality plus heart transplantation rates were 11.3% and 14.7% in patients with complicated presentation and 0% in uncomplicated cases (log-rank P<0.0001). Major AM-related cardiac events after the acute phase (postdischarge death and heart transplantation, sustained ventricular arrhythmias treated with electric shock or ablation, symptomatic heart failure needing device implantation) occurred in 2.8% at the 5-year follow-up, with a higher incidence in patients with complicated forms (10.8% versus 0% in uncomplicated AM; log-rank P<0.0001). β-Adrenoceptor blockers were the most frequently used medications both in complicated (61.9%) and in uncomplicated forms (53.8%; P=0.18). After a median time of 196 days, 200 patients had follow-up cardiac magnetic resonance, and 8 of 55 (14.5%) with complications at presentation had left ventricular ejection fraction <50% compared with 1 of 145 (0.7%) of those with uncomplicated presentation. CONCLUSIONS: In this contemporary study, overall serious adverse events after AM were lower than previously reported. However, patients with left ventricular ejection fraction <50%, ventricular arrhythmias, or low cardiac output syndrome at presentation were at higher risk compared with uncomplicated cases that had a benign prognosis and low risk of subsequent left ventricular systolic dysfunction.
BACKGROUND: There is controversy about the outcome of patients with acute myocarditis (AM), and data are lacking on how patients admitted with suspected AM are managed. We report characteristics, in-hospital management, and long-term outcome of patients with AM based on a retrospective multicenter registry from 19 Italian hospitals. METHODS: A total of 684 patients with suspected AM and recent onset of symptoms (<30 days) were screened between May 2001 and February 2017. Patients >70 years of age and those >50 years of age without coronary angiography were excluded. The final study population comprised 443 patients (median age, 34 years; 19.4% female) with AM diagnosed by either endomyocardial biopsy or increased troponin plus edema and late gadolinium enhancement at cardiac magnetic resonance. RESULTS: At presentation, 118 patients (26.6%) had left ventricular ejection fraction <50%, sustained ventricular arrhythmias, or a low cardiac output syndrome, whereas 325 (73.4%) had no such complications. Endomyocardial biopsy was performed in 56 of 443 (12.6%), and a baseline cardiac magnetic resonance was performed in 415 of 443 (93.7%). Cardiac mortality plus heart transplantation rates at 1 and 5 years were 3.0% and 4.1%. Cardiac mortality plus heart transplantation rates were 11.3% and 14.7% in patients with complicated presentation and 0% in uncomplicated cases (log-rank P<0.0001). Major AM-related cardiac events after the acute phase (postdischarge death and heart transplantation, sustained ventricular arrhythmias treated with electric shock or ablation, symptomatic heart failure needing device implantation) occurred in 2.8% at the 5-year follow-up, with a higher incidence in patients with complicated forms (10.8% versus 0% in uncomplicated AM; log-rank P<0.0001). β-Adrenoceptor blockers were the most frequently used medications both in complicated (61.9%) and in uncomplicated forms (53.8%; P=0.18). After a median time of 196 days, 200 patients had follow-up cardiac magnetic resonance, and 8 of 55 (14.5%) with complications at presentation had left ventricular ejection fraction <50% compared with 1 of 145 (0.7%) of those with uncomplicated presentation. CONCLUSIONS: In this contemporary study, overall serious adverse events after AM were lower than previously reported. However, patients with left ventricular ejection fraction <50%, ventricular arrhythmias, or low cardiac output syndrome at presentation were at higher risk compared with uncomplicated cases that had a benign prognosis and low risk of subsequent left ventricular systolic dysfunction.
Entities:
Keywords:
biopsy; heart transplantation; magnetic resonance imaging; myocarditis; treatment outcome