Prognostic significance of electrocardiographic abnormalities in diphtheritic myocarditis after hospital discharge: a long-term follow-up study.
OBJECTIVE
We aimed to investigate the long-term cardiac mortality and the relationship between cardiac mortality and electrocardiographic abnormalities in patients with diphtheritic myocarditis who survived after hospital discharge.


METHODS
Between 1991 and 1996, 32 patients (all males, mean age 21.00 +/- 3.77 years) surviving diphtheritic myocarditis were included in the study and they were followed up for an average of 16.3 months (range 10.3-26.8 months) after hospital discharge. Clinical evaluation, ECG, and echocardiography were performed on admission, daily while in hospital and at the time of discharge. ECG changes were permanent during the follow-up period. The causes of death of the patients during follow-up period were inferred from the death records of the patients and talking to the people witnessing cardiac arrest.


RESULTS
We observed that the patients with left bundle branch block (LBBB) and T wave inversion at hospital discharge had lower survival rates than that of the patients without these ECG changes in the long term. Although univariate Cox regression analysis identified LBBB (P = 0.001) and T wave inversion (P = 0.014) as the predictors of survival, only LBBB was an independent predictor of survival in multivariate Cox regression analysis. Adjusted hazard ratio was calculated as 13.67 for LBBB (P = 0.001; CI = 2.81-66.28).


CONCLUSIONS
Diphtheritic myocarditis does not only demonstrate a malignant clinical course during acute phase of the disease, but also during the long-term follow-up period, especially in patients with LBBB and T wave inversion. Besides, T wave inversion and LBBB can help us to predict survival rate of the patients in long term. Moreover, LBBB is an independent predictor of long-term survival in diphtheritic myocarditis.
Department of Cardiology, Gulhane Military Medical Academy, Etlik, Ankara, Turkey. benturgay@yahoo.com
Turgay
T
Celik
Nazim
N
Selimov
Afet
A
Vekilova
Hurkan
H
Kursaklioglu
Atila
A
Iyisoy
Selim
S
Kilic
Ersoy
E
Isik
D000328:Adult; D002423:Cause of Death; D004165:Diphtheria / Q000150:complications* / Q000401:mortality / Q000503:physiopathology*; D004452:Echocardiography; D004562:Electrocardiography; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008889:Military Personnel; D009205:Myocarditis / Q000382:microbiology* / Q000401:mortality / Q000503:physiopathology*; D010351:Patient Discharge; D011379:Prognosis; D016016:Proportional Hazards Models; D015996:Survival Rate