Predictors of Mortality in Patients With Biopsy-Proven Viral Myocarditis: 10-Year Outcome Data.
Predictors of Mortality in Patients With Biopsy-Proven Viral Myocarditis: 10-Year Outcome Data.
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活组织检查证实的病毒性心肌炎患者死亡率的预测因素：10年结果数据。
DOI：
10.1161/jaha.119.015351
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发表时间：
2020-08-18
影响因子：
5.4
通讯作者：
Mahrholdt H
中科院分区：
文献类型：
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作者：
Greulich S;Seitz A;Müller KAL;Grün S;Ong P;Ebadi N;Kreisselmeier KP;Seizer P;Bekeredjian R;Zwadlo C;Gräni C;Klingel K;Gawaz M;Sechtem U;Mahrholdt H
关于长期死亡率以及心血管磁共振和晚期钆增强（LGE）在活检证实的病毒性心肌炎患者中的预后价值的数据很少。我们试图调查：（1）死亡率和（2）LGE心血管磁共振（位置、模式、范围和分布）在活检证实的心肌炎患者中的>10年随访中的预后价值。入组了203例经活检证实的病毒性心肌炎和心血管磁共振的连续患者; 183例患者有资格接受标准化随访。中位随访时间为10.1年。终点为全因死亡、心源性死亡和心源性猝死（SCD）。我们发现活检证实的心肌炎患者的长期死亡率相当高（39.3%全因，27.3%心脏病，10.9% SCD）; 101例患者（55.2%）表现出LGE。LGE的存在与死亡风险增加一倍以上相关（风险比[HR]，2.40; 95% CI]，1.30-4.43），心源性死亡的风险升高至3.00（95% CI，1.41-6.42），SCD的风险升高至14.79（95% CI，1.95-112.00）;所有P≤0.009。具体而言，中壁、（前壁-）间隔LGE和LGE的范围与死亡高度相关，所有P<0.001。间隔LGE是SCD的最佳独立预测因子（HR，4.59; 95% CI，1.38-15.24; P=0.01）。在活检证实的病毒性心肌炎患者中，与不存在LGE或其他LGE模式相比，（前）间隔段中存在中壁LGE与更高的死亡率（包括SCD）相关，强调了这些患者中不同LGE分析的预后益处。
There is scarce data about the long‐term mortality as well as the prognostic value of cardiovascular magnetic resonance and late gadolinium enhancement (LGE) in patients with biopsy‐proven viral myocarditis. We sought to investigate: (1) mortality and (2) prognostic value of LGEcardiovascular magnetic resonance (location, pattern, extent, and distribution) in a >10‐year follow‐up in patients with biopsy‐proven myocarditis. Two‐hundred three consecutive patients with biopsy‐proven viral myocarditis and cardiovascular magnetic resonance were enrolled; 183 patients were eligible for standardized follow‐up. The median follow‐up was 10.1 years. End points were all‐cause death, cardiac death, and sudden cardiac death (SCD). We found substantial long‐term mortality in patients with biopsy‐proven myocarditis (39.3% all cause, 27.3% cardiac, and 10.9% SCD); 101 patients (55.2%) demonstrated LGE. The presence of LGE was associated with a more than a doubled risk of death (hazard ratio [HR], 2.40; 95% CI], 1.30–4.43), escalating to a HR of 3.00 (95% CI, 1.41–6.42) for cardiac death, and a HR of 14.79 (95% CI, 1.95–112.00) for SCD; all P≤0.009. Specifically, midwall, (antero‐) septal LGE, and extent of LGE were highly associated with death, all P<0.001. Septal LGE was the best independent predictor for SCD (HR, 4.59; 95% CI, 1.38–15.24; P=0.01). In patients with biopsy‐proven viral myocarditis, the presence of midwall LGE in the (antero‐) septal segments is associated with a higher rate of mortality (including SCD) compared with absent LGE or other LGE patterns, underlining the prognostic benefit of a distinct LGE analysis in these patients.