title: Factors and values at admission that predict a fulminant course of acute myocarditis: data from Tokyo CCU network database.
abstract: Prognosis of acute myocarditis is generally benign, but fulminant cases exist which require advanced life support devices, such as percutaneous cardio-pulmonary support (PCPS) and ventricular assist devices (VAD), and lead to fatal outcomes. The purpose of this study was to identify predictors and their values at admission which might foreshadow a fulminant course of myocarditis. Data from 138 patients (mean age 42.0 years, 79 males) with a diagnosis of acute myocarditis in the Tokyo CCU Network database from 2007 to 2009 were analyzed retrospectively. Patients were divided into fulminant (in-hospital death, or PCPS or VAD requirement, N = 42) and non-fulminant groups (N = 96). Clinical data at admission were compared between them. Overall in-hospital mortality was 14.5%. On multivariate analysis, low systolic blood pressure (BPsys, odds ratio (OR)/mmHg 0.97; 95% confidence interval (CI) 0.93-1.00, p = 0.032) and electrocardiographic QRS complex prolongation (OR/10 ms 1.28; 95% CI 1.10-1.59, p = 0.0034) at admission were independent factors associated with a fulminant course. By receiver operator characteristic curve analysis, the area under the curve predicting a fulminant course was 0.769 for low BPsys and 0.821 for prolongation of QRS duration. The optimal cut-off value was 101 mmHg for BPsys (sensitivity 79.5%, specificity 68.0%), and 120 ms for QRS duration (sensitivity 72.2%, specificity 88.0%). Systolic hypotension and prolonged QRS on admission are predictors of a fulminant course of myocarditis.
authors.affiliation: Tokyo CCU Network Scientific Committee, Tokyo, Japan. oinbcvm@tmd.ac.jp.|Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. oinbcvm@tmd.ac.jp.
authors.forename: Osamu
authors.initials: O
authors.lastname: Inaba
authors.affiliation: Tokyo CCU Network Scientific Committee, Tokyo, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Satoh
authors.affiliation: Tokyo CCU Network Scientific Committee, Tokyo, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
authors.affiliation: Tokyo CCU Network Scientific Committee, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Tokyo CCU Network Scientific Committee, Tokyo, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Nagao
authors.affiliation: Tokyo CCU Network Scientific Committee, Tokyo, Japan.
authors.forename: Morimasa
authors.initials: M
authors.lastname: Takayama
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D019468:Disease Management; D018450:Disease Progression; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006353:Heart-Assist Devices; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000453:epidemiology* / Q000628:therapy; D010343:Patient Admission / Q000639:trends*; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D055815:Young Adult
keywords: Acute myocarditis; Fulminant myocarditis; Percutaneous cardio-pulmonary support; Predictors