Long-term evolution and prognostic stratification of biopsy-proven active myocarditis.

Abstract:

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 model: area 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.

journal_name

Circulation

journal_title

Circulation

authors

Anzini M,Merlo M,Sabbadini G,Barbati G,Finocchiaro G,Pinamonti B,Salvi A,Perkan A,Di Lenarda A,Bussani R,Bartunek J,Sinagra G

doi

10.1161/CIRCULATIONAHA.113.003092

subject

Has Abstract

pub_date

2013-11-26 00:00:00

pages

2384-94

issue

22

eissn

0009-7322

issn

1524-4539

pii

CIRCULATIONAHA.113.003092

journal_volume

128

pub_type

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