Long-Term Evolution and Prognostic Stratification of Biopsy-Proven Active Myocarditis

• Published in: Circulation (New York, N.Y.) Vol. 128; no. 22; pp. 2384 - 2394
• Main Authors: Anzini, Marco, Merlo, Marco, Sabbadini, Gastone, Barbati, Giulia, Finocchiaro, Gherardo, Pinamonti, Bruno, Salvi, Alessandro, Perkan, Andrea, Di Lenarda, Andrea, Bussani, Rossana, Bartunek, Jozef, Sinagra, Gianfranco
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD by the American College of Cardiology Foundation and the American Heart Association, Inc 26.11.2013; Lippincott Williams & Wilkins
• Subjects: Acute Disease; Adult; Biological and medical sciences; Biopsy; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiomegaly - mortality; Cardiomegaly - pathology; Cardiomegaly - physiopathology; Disease-Free Survival; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Follow-Up Studies; Heart; Heart Transplantation - statistics & numerical data; Humans; Male; Medical sciences; Middle Aged; Myocarditis - mortality; Myocarditis - pathology; Myocarditis - physiopathology; Myocarditis. Cardiomyopathies; Outcome Assessment (Health Care); Predictive Value of Tests; Prognosis; Ventricular Dysfunction, Left - mortality; Ventricular Dysfunction, Left - pathology; Ventricular Dysfunction, Left - physiopathology; Young Adult; Prognosis; Cardiomyopathy; Cardiovascular disease; Myocardial disease; Long term; Myocarditis; follow-up studies; Biopsy; Follow up study; Heart disease; Evolution; Circulatory system; Cardiology; Stratification; cardiomyopathies; biopsy; myocarditis
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.113.003092

BACKGROUND—Active myocarditis is characterized by large heterogeneity of clinical presentation and evolution. This study describes the characteristics and the long-term evolution of a large sample of patients with biopsy-proven active myocarditis, looking for accessible and valid early predictors of long-term prognosis. METHODS AND RESULTS—From 1981 to 2009, 82 patients with biopsy-proven active myocarditis were consecutively enrolled and followed-up for 147±107 months. All patients underwent clinical and echocardiographic evaluation at baseline and at 6 months. At this time, improvement/normality of left ventricular ejection fraction (LVEF), defined as a LVEF increase > 20 percentage points or presence of LVEF≥50%, was assessed. At baseline, left ventricular dysfunction (LVEF<50%) and left atrium enlargement were independently associated with long-term heart transplantation–free survival, regardless of the clinical pattern of disease onset. At 6 months, improvement/normality of LVEF was observed in 53% of patients. Persistence of New York Heart Association III to IV classes, left atrium enlargement, and improvement/normality of LVEF at 6 months emerged as independent predictors of long-term outcome. Notably, the short-term reevaluation showed a significant incremental prognostic value in comparison with the baseline evaluation (baseline model versus 6 months modelarea under the curve 0.79 versus 0.90, P=0.03). CONCLUSIONS—Baseline left ventricular function is a marker for prognosis regardless of the clinical pattern of disease onset, and its reassessment at 6 months appears useful for assessing longer-term outcome.