Abstract 13171: The Predictive Factors of Fulminant Course of Acute Myocarditis on Admission
Background The prognosis of acute myocarditis is usually benign. But fulminant cases exist and they need advanced life support devices, such as percutaneous cardio-pulmonary support (PCPS) and ventricular asistant devices (VAD) to survive at acute phase, with few resulted in fatal outcome. The purpose of this study was to clarify the clinical factors which predict the fulminant course of myocarditis on admission.
Methods and Results One-hundred and thirty-eight patients (mean age: 42.0 year, 79 males) with the diagnosis of acute myocarditis in Tokyo CCU Network database from 2007-2009 were analyzed retrospectively. Patients were divided into fulminant group (the cases with in-hospital death, or required PCPS or VAD, N=42) and non-fulminant group (N=96). Clinical symptoms, vital signs, serological findings, ultrasound and electrocardiogram findings on admission between two groups were analyzed. Overall in-hospital mortality was 14.5% (20 patients). On stepwise multivariate analyses, low systolic blood pressure (the odds ratio (OR) per 1mmHg 1.03; 95% confidence interval (CI) 1.00-1.07, p=0.048) and the prolongation of the QRS complex duration (OR per 10msec 1.22; 95% CI 1.10-1.63, p=0.029) were the only independent predictive factors significantly associated with the fulminant course. By receiver operation characteristic curve analysis, the area under the curve to predict fulminant course was 0.769 for low systolic blood pressure and 0.821 for prolongation of QRS complex duration. The optimal cut-off value was 101mmHg for systolic blood pressure (sensitivity: 68.0%, specificity: 80.1%), and 120ms for QRS duration (sensitivity: 72.4%, specificity:88.5%) (Figure). To combine these two variables, sensitivity goes up to 94.3% with specificity 66.7%.
Conclusions Systolic hypotension and prolongation of QRS complex duration on admission are the predictors. of fulminant course of acute myocarditis.
- © 2011 by American Heart Association, Inc.