The long-term prognosis following clinical acute myocarditis was found to be good, regardless of systolic function, according to study results published in The American Journal of Medicine.

This was a retrospective analysis of 320 patients (84% men; mean age, 37 years) clinically diagnosed with acute myocarditis. Patients were divided into 2 groups based on their left ventricular ejection fraction (LVEF) at presentation (<50% or ≥50%). Clinical features were evaluated by electrocardiogram. The study’s primary endpoint was the occurrence of major adverse cardiac events. Secondary endpoints included 30-day, 6-month, and 1-year mortality, as well as the need for escalating therapy.

The mean LVEF in this cohort at presentation was 54±9%. Reduced LVEF was observed in 60 patients. Patients with LVEF <50% vs ≥50% were found to be more likely to have ST depression or T wave inversion (33% vs 18%, respectively; P =.007), higher troponin levels at admission (12.7 µL vs 5.5 µL, respectively; P =.001), and higher peak troponin levels (18.8 µL vs 8.4 µL, respectively; P <.001). 


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Patients with reduced vs normal LVEF were more likely to be treated with steroids during hospitalization (20% vs 9%, respectively; P =.01), but there was no significant difference in steroid prescription rates at discharge.

Major adverse cardiac events, including acute decompensated congestive heart failure, ventricular arrhythmias, and in-hospital mortality, occurred in 25 patients (8%). Patients with reduced vs normal LVEF were more likely to experience adverse cardiovascular events (25% vs 4% respectively; P <.001).

Multivariable analysis indicated that patients with reduced vs normal LVEF were at increased risk for adverse cardiovascular events (hazard ratio, 4.30; 95% CI, 1.59-11.49; P <.001).

Escalating therapy was needed infrequently (n=3), and there were no cases of mortality at 30 days, 6 months, or 1 year.

Study limitations include the use of patient data from a single center in Israel, which may not be representative of global practices.

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“The overall prognosis of patients with clinically diagnosed acute myocarditis is reassuring with relatively low complication rates,” the study authors concluded. “Although those admitted with an LVEF <50% are at a higher risk of in-hospital adverse events, these risks are not necessarily translated into higher long-term mortality.”

Reference

Younis A, Matetzky S, Mulla W, et al. Epidemiology characteristics and outcome of patients with clinically diagnosed acute myocarditis. Am J Med. 2020;133(4):492‐499. doi:10.1016/j.amjmed.2019.10.015