Development of diastolic heart failure in a 6-year follow-up study in patients after acute myocarditis.
BACKGROUND
The aim of this study was to analyse the long-term prognosis of patients with acute myocarditis (AMC) who had been discharged from hospital while having normal left ventricular (LV) function.


RESULTS
50 patients with acute myocarditis who underwent endomyocardial biopsies (EMBs) were prospectively studied. Their clinical condition was examined during a mean follow-up period of 72 (54-78) months, including tissue Doppler imaging (TDI). 4% (2/50) died, and 6% (3/50) developed dilated cardiomyopathy. 45/50 (90%) showed a normal or improvement in LV function over time. In the course of the follow-up, 49% (22/45) suffered from heart failure symptoms despite a normal ejection fraction (HFNEF). This was associated with an abnormal E/A ratio, an impaired deceleration time of early mitral flow velocity and isovolumic relaxation time, and a pathological increase in the LV filling index E/E', in contrast to patients without heart failure symptoms (E/E'(septal) 10.9 (9.3-13.8) vs 6.8 (6.4-9.1); p=0.001). Plasma N-terminal proB-type natriuretic peptide levels were increased threefold in patients with HFNEF (19.9 (10.6-24.1) vs 7.3 (4.2-11.9) pmol/l; p=0.006).


CONCLUSIONS
It is assumed that the evidence for AMC is associated not only with the risk of developing LV dilatation but also with an increased risk of symptomatic diastolic dysfunction after several years.
Department of Cardiology and Pneumonology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
Felicitas
F
Escher
Dirk
D
Westermann
Regina
R
Gaub
Johannes
J
Pronk
Thomas
T
Bock
Nidal
N
Al-Saadi
Uwe
U
Kühl
Heinz-Peter
HP
Schultheiss
Carsten
C
Tschöpe
D000208:Acute Disease; D000328:Adult; D005260:Female; D016679:Genome, Viral; D054144:Heart Failure, Diastolic / Q000209:etiology* / Q000503:physiopathology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007150:Immunohistochemistry; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000150:complications*; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000209:etiology