Abstract 17976: Biopsy-proven Myocarditis: Young Age, Female Gender and Right Ventricular Dysfunction at Diagnosis are Independent Predictors of Death or Transplantation in a Contemporary Prospective Series
Clinical presentation in biopsy-proven myocarditis is variable and prognostic features, including the detection of viral genome by polymerase chain reaction (PCR) on endomyocardial biopsy (EMB) remain controversial. Prospective clinical data are lacking.
Purpose: Aim of this study was to identify clinical and etiopathogenetic predictors of death or heart transplantation (HTx) in biopsy-proven myocarditis.
Methods: Our prospective cohort studied 201 consecutive myocarditis patients, 125 males, aged 36 ± 17 years, follow-up 52 ± 44 months. All patients were invited to attend regular cardiological follow-up evaluation at a dedicated outpatient clinic after hospital discharge. EMB at diagnosis showed in 102 patients active, in 99 borderline myocarditis (Dallas criteria), 6 had virus-negative giant cell myocarditis. PCR based techniques were used to detect genome for cardiotropic viruses, including Parvovivus B19, on EMB. Univariate and multivariable logistic regression analyses for death or HTx status were used.
Results: At last follow-up in May 2010, 145 patients were alive, 30 were dead or transplanted, 26 were lost to follow-up. Actuarial survival (Kaplan Meier) was of 82% at 6 years. In 27% of patients PCR was positive for virus. Univariate predictors of death/HTx were: longer symptom duration, giant cell myocarditis, NYHA II-IV, presentation with left ventricular (LV) dysfunction, clinical signs/symptoms of heart failure, multiple echocardiographic and hemodynamic indexes of LV and right ventricular (RV) dysfunction. Conversely, positive PCR for virus was not associated with death or HTx. Independent predictors of death or HTx by multivariable logistic regression models were female gender (OR 0.20, p=0.005, 95%CI 0.06–0.61), young age (OR 0.96, p=0.03, 95%CI 0.93–0.99) and increased RV end-diastolic pressure at cardiac catheterization (OR 1.12, p=0.007, 95%CI 1.03–1.21).
Conclusions: In biopsy-proven myocarditis, young age, female gender and RV dysfunction at diagnosis were the main independent predictors for death or HTx in the mid-term. Positive PCR status for virus did not identify a subgroup with dismal prognosis.
- © 2010 by American Heart Association, Inc.