Can troponin elevation predict worse prognosis in patients with acute pericarditis?
BACKGROUND
Myopericarditis are common in clinical practice: up to 15% of acute pericarditis have a significant myocardial involvement as assessed by biological markers. This prospective, bicentric study is aimed at describing a myopericarditis population, the clinical and MRI follow-up, and search for prognosis markers.


METHODS
Between May 2005 and September 2007, 103 patients hospitalised for acute pericarditis were prospectively enrolled. Physical examination, ECG, echocardiography, biological screening and cardiac MRI, in case of myopericarditis defined as acute pericarditis with troponin I elevation, were performed. Between December 2007 and July 2008, patients were contacted for new clinical and MRI evaluation.


RESULTS
Among the initial population of 103 patients admitted for acute pericarditis, 14 myopericarditis and 38 pericarditis were included. Compared with pericarditis, the myopericarditis group was associated with the following features: younger age (34.9 years [95% CI 28.3-41.2]; p=0.01), ST-segment elevation (nine patients between 14; p=0.03), higher troponin I (7.3 microg/L [95% CI 4.4-10.2]; p<10(-4)) and lower systemic inflammation (CRP peak 38.1mg/L [95% CI 7-69.2]; p=0.01). In the case of myopericarditis, infectious etiologies were predominant (12 patients among 14; p=0.002) and patients stayed longer in hospital (5.8 days [95% CI 4.7-6.8]; p=0.01). Follow-up showed no difference in terms of functional status (p=0.3) and global complications (p=0.9) between paired myopericarditis and pericarditis. Nevertheless, cardiac mortality was higher for myopericarditis (p=0.04). MRI follow-up showed myocardial sequelae without clinical impact.


CONCLUSIONS
Myopericarditis significantly distinguished from pericarditis. Three years follow-up showed no difference in terms of global complications but a higher cardiac mortality for myopericarditis. MRI myocardial lesions did not develop into symptomatic sequelae.
Machado
S
S
Département de cardiologie, CHU Arnaud-de-Villeneuve, 371 avenue du Doyen-Gaston-Giraud, Montpellier, France.
Roubille
F
F
Gahide
G
G
Vernhet-Kovacsik
H
H
Cornillet
L
L
Cung
T T
TT
Sportouch-Dukhan
C
C
Raczka
F
F
Pasquié
J L
JL
Gervasoni
R
R
Macia
J C
JC
Cransac
F
F
Davy
J-M
JM
Piot
C
C
Leclercq
F
F
D000208:Acute Disease; D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D009206:Myocardium / Q000473:pathology; D010493:Pericarditis / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D010496:Pericardium / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D016019:Survival Analysis; D019210:Troponin I / Q000097:blood*
D019210:Troponin I; D002097:C-Reactive Protein