Valerie Pavlicek1, Ingrid Kindermann1, Jan Wintrich1, Felix Mahfoud1, Karin Klingel2, Michael Böhm1, Christian Ukena3. 1. Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany. 2. Kardiopathologie, Institut für Pathologie und Neuropathologie, Eberhard-Karls-Universität Tübingen, Germany. 3. Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany. Electronic address: Christian.Ukena@uniklinikum-saarland.de.
Abstract
BACKGROUND: Inflammatory heart disease is known to be associated with ventricular arrhythmias (VA) and impaired ventricular function at presentation or during follow-up. We aimed to investigate the need for implanted cardioverter defibrillator (ICD) due to ventricular dysfunction and occurrence of VA during long-term follow-up in patients admitted with suspected myocarditis. METHODS: Between 2000 and 2016, 191 patients (age 43 ± 13 years, 71% male, mean left ventricular ejection fraction (LVEF) 33 ± 15%) with clinically suspected myocarditis, who underwent endomyocardial biopsies (EMB), were prospectively enrolled and followed up in 6-months-intervals (median follow-up was 83 (49-156) months). The primary endpoint was deterioration of cardiac function (LVEF ≤ 35%) or occurrence of VA leading to ICD implantation. RESULTS: According to EMB results, patients were stratified in three diagnostic groups: acute myocarditis (5%), chronic myocarditis (50%) and dilated cardiomyopathy (DCM) (45%). An ICD implantation was performed in 58 patients (30%, n = 38 for primary prevention). Besides LVEF at baseline, chronic myocardial inflammation was the only independent predictor of ICD implantation for primary prevention (hazard ratio 2.48 (95% confidence interval 1.02-5.5); p = 0.045). VA requiring ICD therapy occurred in 29 of 58 patients (50%) after a median of 14 (2-37) months without a significant difference between presence and absence of myocardial inflammation. CONCLUSIONS: Nearly one third of patients with suspected myocarditis require an ICD due to impaired LVEF or occurrence of VA. Half of these patients experienced VA with adequate ICD therapy.
BACKGROUND: Inflammatory heart disease is known to be associated with ventricular arrhythmias (VA) and impaired ventricular function at presentation or during follow-up. We aimed to investigate the need for implanted cardioverter defibrillator (ICD) due to ventricular dysfunction and occurrence of VA during long-term follow-up in patients admitted with suspected myocarditis. METHODS: Between 2000 and 2016, 191 patients (age 43 ± 13 years, 71% male, mean left ventricular ejection fraction (LVEF) 33 ± 15%) with clinically suspected myocarditis, who underwent endomyocardial biopsies (EMB), were prospectively enrolled and followed up in 6-months-intervals (median follow-up was 83 (49-156) months). The primary endpoint was deterioration of cardiac function (LVEF ≤ 35%) or occurrence of VA leading to ICD implantation. RESULTS: According to EMB results, patients were stratified in three diagnostic groups: acute myocarditis (5%), chronic myocarditis (50%) and dilated cardiomyopathy (DCM) (45%). An ICD implantation was performed in 58 patients (30%, n = 38 for primary prevention). Besides LVEF at baseline, chronic myocardial inflammation was the only independent predictor of ICD implantation for primary prevention (hazard ratio 2.48 (95% confidence interval 1.02-5.5); p = 0.045). VA requiring ICD therapy occurred in 29 of 58 patients (50%) after a median of 14 (2-37) months without a significant difference between presence and absence of myocardial inflammation. CONCLUSIONS: Nearly one third of patients with suspected myocarditis require an ICD due to impaired LVEF or occurrence of VA. Half of these patients experienced VA with adequate ICD therapy.
Authors: Fabiola B Sozzi; Elisa Gherbesi; Andrea Faggiano; Eleonora Gnan; Alessio Maruccio; Marco Schiavone; Laura Iacuzio; Stefano Carugo Journal: Front Cardiovasc Med Date: 2022-06-20
Authors: Amy R Kontorovich; Nihir Patel; Arden Moscati; Felix Richter; Inga Peter; Enkhsaikhan Purevjav; Simina Ramona Selejan; Ingrid Kindermann; Jeffrey A Towbin; Michael Bohm; Karin Klingel; Bruce D Gelb Journal: JACC Basic Transl Sci Date: 2021-07-26