Acute Myocarditis Complicated by LVSD Has Different Presentation, Outcomes

Myocarditis in heart wall
Myocarditis in heart wall
Acute myocarditis complicated by left ventricular systolic dysfunction confers a higher risk for cardiac death and heart transplant compared with uncomplicated acute myocarditis.

Patients who presented with acute myocarditis with left ventricular (LV) systolic dysfunction were more likely to experience cardiac death or require a heart transplant compared with patients who presented with uncomplicated acute myocarditis, according to a study published by Circulation.

Medical records data from patients at 19 hospitals presenting with clinically suspected acute myocarditis were examined for clinical presentation and outcomes were compared between groups. The primary outcome measurement was the overall incidence of cardiac death and heart transplants.

Of the 443 patients in the study, 118 were categorized into group 1 (acute myocarditis complicated by LV systolic dysfunction, ie, LV ejection fraction <50% at first in-hospital echocardiogram) and 325 were categorized into group 2 (uncomplicated acute myocarditis). 

Treatment differed substantially between the two groups; immunosuppressive agents, in particular intravenous steroids, were used in up to 37.2% of patients in group 1 compared with 2.8% of patients in group 2 (P <.0001). In addition, nonsteroidal anti-inflammatory drugs were more frequently used in group 2 than in group 1 (67.6% vs 44.0%, respectively; P <.0001).

A total of 10 cardiac deaths and 4 heart transplants occurred, and only in patients in group 1. Cardiac mortality and heart transplants at 1-, 3-, and 5- year follow-up were 11.3%, 12.5%, and 14.7%, respectively, in group 1 compared with 0% in group 2.

The study investigators wrote, “Cardiac mortality and [heart transplant] both in the short (in-hospital, 11.9%) and long term (18.0% at 5 years follow-up) occurred exclusively in patients with complicated [acute myocarditis].”

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They added, “This overall approach might also help identify the most effective allocation of available resources although large multicenter, prospective studies are needed to confirm our findings.”


Ammirati E, Cipriani M, Moro C, et al; on behalf of the Registro Lombardo delle Miocarditi. Clinical presentation and outcome in a contemporary cohort of patients with acute myocarditis: The Multicenter Lombardy Registry [published online May 15, 2018]. Circulation. doi:10.1161/CIRCULATIONAHA.118.035319