A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis
A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis
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DOI：
10.1093/eurheartj/ehm076
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发表时间：
2007-06-01
影响因子：
39.3
通讯作者：
Daliento, Luciano
中科院分区：
文献类型：
--
作者：
Caforio, Alida L. P.;Calabrese, Fiorelta;Daliento, Luciano
目的 心肌炎可能是特发性、病毒性和/或免疫性的；这些形式的发生频率和预后尚不明确。我们的目的是确定心肌炎的病因和预后标志物，包括通过聚合酶链反应 (PCR) 进行心内膜心肌活检 (EMB) 的病毒基因组和血清抗心脏自身抗体 (AHA)。 方法和结果 我们研究了 174 名患者，110 名男性，年龄 36 +/- 18 岁，中位随访 23.5 个月，范围 10-54； 85 名患者患有活动性心肌炎，89 名患者患有边缘性心肌炎（无弥漫性或严重炎症）（达拉斯标准）。采用间接免疫荧光法检测血清AHA。 PCR用于检测病毒。六年精算生存率为 73%。 56% 的患者检测到 AHA，26% 的患者检测到 PCR 阳性。死亡/移植的单变量预测因素包括年轻、症状持续时间较长、巨细胞心肌炎、NYHA II-IV、PCR阳性、左心室功能不全、心力衰竭的临床体征/症状以及心功能不全的超声心动图和血流动力学指标。通过Cox单变量分析，左心衰竭（HR = 4.3，CI 1.7-10.8，P = 0.002）和右心衰竭（HR 3.4，CI 1.5-7.3，P = 0.002）的临床体征/症状赋予最高风险。 结论 在心肌炎中，诊断时的双心室功能障碍是死亡/移植的主要预测因素。 AHA 在大多数病例中发现了免疫介导的心肌炎。病毒基因组是不良预后的单变量预测因子。我们使用 AHA 和阳性 PCR 作为病因标记的方法应该有助于在未来的病因治疗研究中选择和招募患者。
Aims Myocarditis may be idiopathic, viral, and/or immune; frequency of these forms and prognosis are ill-defined. We aimed at identifying aetiopathogenetic and prognostic markers in myocarditis, including viral genome on endomyocardial biopsy (EMB) by polymerase chain reaction (PCR) and serum anti-heart autoantibodies (AHA).Methods and results We studied 174 patients, 110 mates, aged 36 +/- 18 years, median follow-up 23.5 months, range 10-54; 85 patients had active myocarditis and 89 borderline myocarditis (no diffuse or severe inflammation) (Dallas criteria). Serum AHA were detected by indirect immunofluorescence. PCR was used to detect virus. Six-year actuarial survival was 73%. AHA were found in 56% of patients and positive PCR in 26%. Univariate predictors of death /transplantation were young age, longer symptom duration, giant cell myocarditis, NYHA II-IV, positive PCR, presentation with LV dysfunction, clinical signs/symptoms of heart failure, and echocardiographic and haemodynamic indexes of cardiac dysfunction. By Cox univariate analysis, highest risk was conferred by clinical signs/symptoms of left (HR = 4.3, CI 1.7-10.8, P= 0.002) and right heart failure (HR 3.4, CI 1.5-7.3, P= 0.002).Conclusion In myocarditis, biventricular dysfunction at diagnosis was the main predictor of death/ transplantation. AHA identified immune-mediated myocarditis in the majority of cases. Viral genome was a univariate predictor of adverse prognosis. Our approach of using AHA and positive PCR as aetiopathogenetic markers should help patient selection and recruitment in future studies on aetiological therapy.