Abstract 13976: Predictors of Death, Heart Transplantation and Relapse in Biopsy-proven and Clinically Suspected Myocarditis: a Prospective Study
Myocarditis may resolve, relapse or lead to dilated cardiomyopathy, death or transplantation. A positive result for serum autoantibodies, anti-heart (AHA), anti-intercalated disk (AIDA), and anti-nucleus (ANA), identifies autoimmune forms. Predictors of poor prognosis in biopsy-proven myocarditis (BPM) and in clinically suspected myocarditis (CSM) are not well defined.
Purpose: To identify predictors of death, cardiac transplantation and relapse in BPM and in CSM, defined on the basis of a plausible clinical scenario, normal coronary arteries, and Cardiac Magnetic Resonance (CMR) findings.
Methods: We studied 466 patients (317 male, mean age 37 ± 17 years, median follow-up 50 months), of whom 250 BPM and 216 CSM. All patients underwent selective coronary angiography. Serum AHA, AIDA, and ANA were measured by indirect immunofluorescence. Univariate and multivariable Cox regression analysis was used.
Results: At the last follow-up, 366 were alive (89.7%), 42 were dead or transplanted (10.3%) and 58 patients were lost. Survival free from death or transplantation at 10 years was 83% in the whole group and was lower in BPM compared to CSM (76% vs 94% respectively, p<0.001). Univariate predictors of negative prognosis were: female gender, history of myocarditis, heart failure presentation, advanced NYHA class, giant-cell myocarditis, AHA and ANA. Independent predictors of death or heart transplantation were: female gender, a lower left ventricular echocardiographic ejection fraction, high titre organ-specific AHA and ANA. Univariate predictors of relapse were: young age, history of myocarditis, presence of symptoms before diagnosis, a diffuse CMR pattern of late gadolinium enhancement, and positivity for AIDA. Multivariate analysis identified young age and history of myocarditis as independent predictors of relapse.
Conclusions: Independent predictors of death and cardiac transplantation in myocarditis included ventricular dysfunction at presentation, female gender and autoimmune markers, in particular high titre AHA and ANA. Independent predictors of relapse were young age and history of myocarditis. Prognostic predictors did not differ between BPM and CSM, suggesting that the latter is part of the myocarditis spectrum.
- © 2013 by American Heart Association, Inc.