Piero Gentile1,2, Marco Merlo1, Giovanni Peretto3, Enrico Ammirati2, Simone Sala3, Paolo Della Bella3, Giovanni Donato Aquaro4, Massimo Imazio5, Luciano Potena6, Jeness Campodonico7,8, Alberto Foà6, Anne Raafs9, Mark Hazebroek8, Michela Brambatti10, Andreja Cerne Cercek11, Gaetano Nucifora12,13, Sanskriti Shrivastava14, Florent Huang15, Matthieu Schmidt16, Daniele Muser17, Caroline M Van de Heyning18, Emeline Van Craenenbroeck18, Tatsuo Aoki19, Koichiro Sugimura19, Hiroaki Shimokawa19, Antonio Cannatà1,20, Jessica Artico1, Aldostefano Porcari1, Marzia Colopi5, Andrea Perkan1, Rossana Bussani21, Giulia Barbati22, Andrea Garascia2, Manlio Cipriani2, Piergiuseppe Agostoni7,8, Naveen Pereira13, Stephane Heymans8, Eric D Adler9, Paolo Guido Camici23, Maria Frigerio2, Gianfranco Sinagra1. 1. Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste, Trieste, Italy. 2. De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milan, Italy. 3. Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital and Vita-Salute University, Milan, Italy. 4. Fondazione Toscana G. Monasterio, Pisa, Italy. 5. Cardiology, Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", ASUFC, Udine, Italy. 6. IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy. 7. Centro Cardiologico Monzino, IRCCS, Milan, Italy. 8. Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy. 9. Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands. 10. Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA. 11. Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia. 12. College of Medicine and Public Health, Flinders University, Bedford Park, Australia. 13. Manchester University NHS Foundation Trust, Manchester, UK. 14. Division of Cardiovascular Diseases, Mayo Clinic, Rochester, NY, USA. 15. Department of Cardiology, Foch Hospital, Suresnes, France. 16. Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pítié-Salpêtriére Hospital, Medical Intensive Care Unit, Paris, France. 17. Cardiothoracic Department, University Hospital, Udine, Italy. 18. Department of Cardiology, Antwerp University Hospital, Edegem, Belgium. 19. Tohoku University Graduate School of Medicine, Sendai, Japan. 20. Department of Cardiology, King's College Hospital, London, UK. 21. Department of Pathological Anatomy, Azienda Sanitaria Universitaria Integrata di Trieste and University of Trieste, Trieste, Italy. 22. Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy. 23. Vita Salute University and San Raffaele Hospital, Milan, Italy.
Abstract
AIMS: The outcomes of patients presenting with acute myocarditis and life-threatening ventricular arrhythmias (LT-VA) are unclear. The aim of this study was to assess the incidence and predictors of recurrent major arrhythmic events (MAEs) after hospital discharge in this patient population. METHODS AND RESULTS: We retrospectively analysed 156 patients (median age 44 years; 77% male) discharged with a diagnosis of acute myocarditis and LT-VA from 16 hospitals worldwide. Diagnosis of myocarditis was based on histology or the combination of increased markers of cardiac injury and cardiac magnetic resonance (CMR) Lake Louise criteria. MAEs were defined as the relapse, after discharge, of sudden cardiac death or successfully defibrillated ventricular fibrillation, or sustained ventricular tachycardia (sVT) requiring implantable cardioverter-defibrillator therapy or synchronized external cardioversion. Median follow-up was 23 months [first to third quartile (Q1-Q3) 7-60]. Fifty-eight (37.2%) patients experienced MAEs after discharge, at a median of 8 months (Q1-Q3 2.5-24.0 months; 60.3% of MAEs within the first year). At multivariable Cox analysis, variables independently associated with MAEs were presentation with sVT [hazard ratio (HR) 2.90, 95% confidence interval (CI) 1.38-6.11]; late gadolinium enhancement involving ≥2 myocardial segments (HR 4.51, 95% CI 2.39-8.53), and absence of positive short-tau inversion recovery (STIR) (HR 2.59, 95% CI 1.40-4.79) at first CMR. CONCLUSIONS: Among patients discharged with a diagnosis of myocarditis and LT-VA, 37.2% had recurrences of MAEs during follow-up. Initial CMR pattern and sVT at presentation stratify the risk of arrhythmia recurrence.
AIMS: The outcomes of patients presenting with acute myocarditis and life-threatening ventricular arrhythmias (LT-VA) are unclear. The aim of this study was to assess the incidence and predictors of recurrent major arrhythmic events (MAEs) after hospital discharge in this patient population. METHODS AND RESULTS: We retrospectively analysed 156 patients (median age 44 years; 77% male) discharged with a diagnosis of acute myocarditis and LT-VA from 16 hospitals worldwide. Diagnosis of myocarditis was based on histology or the combination of increased markers of cardiac injury and cardiac magnetic resonance (CMR) Lake Louise criteria. MAEs were defined as the relapse, after discharge, of sudden cardiac death or successfully defibrillated ventricular fibrillation, or sustained ventricular tachycardia (sVT) requiring implantable cardioverter-defibrillator therapy or synchronized external cardioversion. Median follow-up was 23 months [first to third quartile (Q1-Q3) 7-60]. Fifty-eight (37.2%) patients experienced MAEs after discharge, at a median of 8 months (Q1-Q3 2.5-24.0 months; 60.3% of MAEs within the first year). At multivariable Cox analysis, variables independently associated with MAEs were presentation with sVT [hazard ratio (HR) 2.90, 95% confidence interval (CI) 1.38-6.11]; late gadolinium enhancement involving ≥2 myocardial segments (HR 4.51, 95% CI 2.39-8.53), and absence of positive short-tau inversion recovery (STIR) (HR 2.59, 95% CI 1.40-4.79) at first CMR. CONCLUSIONS: Among patients discharged with a diagnosis of myocarditis and LT-VA, 37.2% had recurrences of MAEs during follow-up. Initial CMR pattern and sVT at presentation stratify the risk of arrhythmia recurrence.
Authors: Enrico Ammirati; Emanuele Bizzi; Giacomo Veronese; Matthieu Groh; Caroline M Van de Heyning; Jukka Lehtonen; Marc Pineton de Chambrun; Alberto Cereda; Chiara Picchi; Lucia Trotta; Javid J Moslehi; Antonio Brucato Journal: Front Med (Lausanne) Date: 2022-03-07