Predictors of outcome in patients with suspected myocarditis
Predictors of outcome in patients with suspected myocarditis
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DOI：
10.1161/circulationaha.108.769489
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发表时间：
2008-08-05
期刊：
影响因子：
37.8
通讯作者：
Boehm, Michael
中科院分区：
文献类型：
--
作者：
Kindermann, Ingrid;Kindermann, Michael;Boehm, Michael
Background - The objective of this study was to identify the prognostic indicators in patients with suspected myocarditis who underwent endomyocardial biopsy.Methods and Results - Between 1994 and 2007, 181 consecutive patients ( age, 42 +/- 15 years) with clinically suspected viral myocarditis were enrolled and followed up for a mean of 59 +/- 42 months. Endomyocardial biopsies were studied for inflammation with histological ( Dallas) and immunohistological criteria. Virus genome was detected by polymerase chain reaction. The primary end point was time to cardiac death or heart transplantation. In 38% of the patients ( n = 69), the Dallas criteria were positive. Immunohistological signs of inflammation were shown in 50% ( n = 91). Genomes of cardiotropic virus species were detected in 79 patients ( 44%). During follow- up, 22% of the patients ( n = 40) reached the primary end point. Three independent predictors were identified for the primary end point, namely New York Heart Association class III or IV at entry ( hazard ratio, 3.20; 95% confidence interval, 1.36 to 7.57; P = 0.008), immunohistological evidence of inflammatory infiltrates in the myocardium ( hazard ratio, 3.46; 95% confidence interval, 1.39 to 8.62; P = 0.008), and beta- blocker therapy ( hazard ratio, 0.43; 95% confidence interval, 0.21 to 0.91; P = 0.027). Ejection fraction, left ventricular end- diastolic pressure, and left ventricular end- diastolic dimension index were predictive only in univariate, not in multivariate, analysis. Neither the Dallas criteria nor the detection of viral genome was a predictor of outcome.Conclusions - For patients with suspected myocarditis, advanced New York Heart Association functional class, immunohistological signs of inflammation, and lack of beta-blocker therapy, but not histology ( positive Dallas criteria) or viral genome detection, are related to poor outcome.
