Long-Term Evolution and Prognostic Stratification of Biopsy-Proven Active Myocarditis
2013; Lippincott Williams & Wilkins; Volume: 128; Issue: 22 Linguagem: Inglês
10.1161/circulationaha.113.003092
ISSN1524-4539
AutoresMarco Anzini, Marco Merlo, Gastone Sabbadini, Giulia Barbati, Gherardo Finocchiaro, Bruno Pinamonti, Alessandro Salvi, Andrea Perkan, Andrea Di Lenarda, Rossana Bussani, Jozef Bartúnek, Gianfranco Sinagra,
Tópico(s)Cytomegalovirus and herpesvirus research
ResumoActive 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.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 model: area under the curve 0.79 versus 0.90, P=0.03).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.
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