Predictors of relapse, death or heart transplantation in myocarditis before the introduction of immunosuppression: negative prognostic impact of female gender, fulminant onset, lower ejection fraction and serum autoantibodies
Predictors of relapse, death or heart transplantation in myocarditis before the introduction of immunosuppression: negative prognostic impact of female gender, fulminant onset, lower ejection fraction and serum autoantibodies
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DOI：
10.1002/ejhf.2496
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发表时间：
2022-04-19
影响因子：
18.2
通讯作者：
Caforio, Alida Linda Patrizia
中科院分区：
文献类型：
--
作者：
Baritussio, Anna;Schiavo, Alessandro;Caforio, Alida Linda Patrizia
目的心肌炎的预后预测因素尚未明确；我们的目的是在引入免疫抑制之前确定死亡、心脏移植（HTx）和复发的预测因素。方法和结果1992 - 2012年，纳入466例连续患者（68%为男性，平均年龄37 +/- 17岁，单中心招募，中位随访50个月），其中216例临床怀疑心肌炎，250例活检证实心肌炎。间接免疫荧光法检测血清抗心脏（AHA）和抗插盘（AIDA）自身抗体。对诊断时的临床和诊断特征进行单变量和多变量分析。在整个研究人群中，10年无死亡或HTx的生存率为83%，活检证实的心肌炎患者的生存率低于临床怀疑的心肌炎患者（76%对94%，p < 0.001）。女性性别（风险比[HR] 2.7, 95%可信区间[CI] 1.1-6.5）、暴发性表现（HR 13.77, 95% CI 9.7-261.73）、高滴度器官特异性AHA （HR 4.2, 95% CI 1.2-14.7）和抗核抗体（HR 5.2, 95% CI 2.1-12.8）是死亡或HTx的独立预测因素；诊断时较高的超声心动图左心室射血分数（LVEF）具有保护作用，LVEF每增加1%，风险降低0.93倍（95% CI 0.89-0.96）。诊断时心肌炎病史（HR 8.5, 95% CI 3.5-20.7）是随访时心肌炎复发的独立预测因子；年龄较大具有保护作用（HR 0.95, 95% CI 0.91-0.99）。死亡、HTx和复发的预测因子在活检证实的和临床怀疑的心肌炎中没有差异。结论年轻和既往心肌炎是心肌炎复发的独立预测因素；女性、暴发性发病、就诊时较低的LVEF和高滴度器官特异性AHA和ANA是死亡和HTx的独立预测因素，表明自身免疫特征预测较差的预后。
Aims Outcome predictors in myocarditis are not well defined; we aimed at identifying predictors of death, heart transplantation (HTx) and relapse before the introduction of immunosuppression. Methods and results From 1992 to 2012, 466 consecutive patients (68% male, mean age 37 +/- 17 years, single centre recruitment, median follow-up 50 months) were included, of whom 216 had clinically suspected and 250 biopsy-proven myocarditis. Serum anti-heart (AHA) and anti-intercalated disk (AIDA) autoantibodies were measured by indirect immunofluorescence. Univariable and multivariable analyses of clinical and diagnostic features at diagnosis were performed. Survival free from death or HTx at 10 years was 83% in the whole study population and was lower in biopsy-proven versus clinically suspected myocarditis (76% vs. 94%, p < 0.001). Female gender (hazard ratio [HR] 2.7, 95% confidence interval [CI] 1.1-6.5), fulminant presentation (HR 13.77, 95% CI 9.7-261.73), high-titre organ-specific AHA (HR 4.2, 95% CI 1.2-14.7) and anti-nuclear antibodies (ANA) (HR 5.2, 95% CI 2.1-12.8) were independent predictors of death or HTx; higher echocardiographic left ventricular ejection fraction (LVEF) at diagnosis was protective, with a 0.93-fold risk reduction for each 1% LVEF increase (95% CI 0.89-0.96). History of myocarditis at diagnosis (HR 8.5, 95% CI 3.5-20.7) was an independent predictor of myocarditis relapse at follow-up; older age was protective (HR 0.95, 95% CI 0.91-0.99). Predictors of death, HTx and relapse did not differ in biopsy-proven versus clinically suspected myocarditis. Conclusions Young age and a previous myocarditis were independent relapse predictors; female gender, fulminant onset, lower LVEF at presentation and high-titre organ-specific AHA and ANA were independent predictors of death and HTx, suggesting that autoimmune features predict worse prognosis.