A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis.
OBJECTIVE
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).


RESULTS
We studied 174 patients, 110 males, 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).


CONCLUSIONS
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.
Caforio
Alida L P
AL
Division of Cardiology, Department of Cardiological, Thoracic, and Vascular Sciences, University of Padova-Policlinico, Centro V. Gallucci, Via Giustiniani 2, 35128 Padua, Italy. alida.caforio@unipd.it
Calabrese
Fiorella
F
Angelini
Annalisa
A
Tona
Francesco
F
Vinci
Annalisa
A
Bottaro
Stefania
S
Ramondo
Angelo
A
Carturan
Elisa
E
Iliceto
Sabino
S
Thiene
Gaetano
G
Daliento
Luciano
L
D000328:Adult; D001323:Autoantibodies / Q000032:analysis; D001706:Biopsy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D009205:Myocarditis / Q000209:etiology / Q000276:immunology / Q000473:pathology*; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis; D016133:Polymerase Chain Reaction; D011446:Prospective Studies
D001323:Autoantibodies