Clinicopathological correlates can predict acute myocarditis in patients with recent-onset heart failure: preliminary data.
BACKGROUND
The aim of this study was to verify whether or not the clinical profile could be helpful in diagnosing myocarditis in patients with recent-onset (< 6 months) heart failure, suspected myocarditis and a biopsy-proven diagnosis.


METHODS
From March 1998 to December 2000, 118 patients underwent a complete clinical, hemodynamic, echocardiographic and laboratory examination and a diagnostic endomyocardial biopsy in our Department; among them, 28 patients were admitted with clinically suspected myocarditis; in 9, the diagnosis was confirmed by the histopathologic findings.


RESULTS
At the time of presentation, patients with biopsy-proven myocarditis showed early in-hospital admission (median 6 vs 69 days) with fever, a higher sinus rate and a significantly lower systolic blood pressure. Left ventricular dilation was observed in the non-myocarditis group only (left ventricular end-diastolic diameter 65.0 +/- 8.9 vs 52.6 +/- 5.8 mm); right ventricular function, as assessed by evaluation of the tricuspid annulus plane systolic excursion (TAPSE) and the right ventricular ejection fraction (RVEF) were found to be significantly lower in the myocarditis group (TAPSE 14.2 +/- 3.6 vs 20.3 +/- 7.0 mm; RVEF 21.3 +/- 11.1 vs 30.3 +/- 11.5%). Only patients with biopsy-proven myocarditis had an increase in serum creatine kinase and inflammatory markers (erythrocyte sedimentation rate and white blood cell count). Three cases had a clinical presentation of fulminant myocarditis showing marked increases in the serum levels of creatine kinase and inflammatory markers, and severely compromised right ventricular function and cardiac index.


CONCLUSIONS
At univariate analysis, an early onset, fever, tachycardia, hypotension, a reduced right ventricular function, increased creatine kinase, erythrocyte sedimentation rate and white blood cell count were predictive of myocarditis. In patients with recent-onset heart failure, the clinical, laboratory and echocardiographic profiles can suggest, but not prove, a diagnosis of myocarditis.
Campana
Carlo
C
Dipartimento di Cardiologia, IRCCS Policlinico San Matteo Piazzale Golgi, 2 27100 Pavia. unita.sc@smatteo.pv.it
Monti
Lorenzo
L
Arbustini
Eloisa
E
Constantin
Cristina
C
Scelsi
Laura
L
Serio
Alessandra
A
Ghio
Stefano
S
Klersy
Catherine
C
Tavazzi
Luigi
L
D000208:Acute Disease; D000328:Adult; D001794:Blood Pressure; D001799:Blood Sedimentation; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000175:diagnosis* / Q000473:pathology; D016278:Ventricular Function, Right
D003402:Creatine Kinase