Long-Term Evolution and Prognostic Stratification of Biopsy-Proven Active Myocarditis
Background—Active myocarditis (AM) is characterized by large heterogeneity of clinical presentation and evolution. This study describes the characteristics and the long-term evolution of a large sample of patients with biopsy-proven active AM, looking for accessible and valid early predictors of long-term prognosis.
Methods and Results—From 1981 to 2009, 82 patients with biopsy-proven AM were consecutively enrolled and followed-up for 147±107 months. All patients underwent clinical and echocardiographic evaluation at baseline and at 6 months. At this time, improvement/normality of left ventricular ejection fraction (LVEF), defined as a LVEF increase > 20 percentage points and/or presence of LVEF≥50%, was assessed. At baseline, left ventricular (LV) dysfunction (LVEF <50%) and left atrium enlargement were independently associated with long-term heart transplantation (HTx)-free survival, regardless of the clinical pattern of disease onset. At 6 months, improvement/normality of LVEF was observed in 53% of patients. Persistence of NYHA III-IV classes, left atrium enlargement and improvement/normality of LVEF at 6 months emerged as independent predictors of long-term outcome. Notably, the short-term revaluation showed a significant incremental prognostic value when compared to the baseline evaluation (baseline model vs 6 months model: Area Under the Curve 0.79 vs 0.90, p=0.03).
Conclusions—Baseline LV function is a marker for prognosis regardless of the clinical pattern of disease onset and its reassessment at 6 months appears useful for assessing longer term outcome.
- Received April 11, 2013.
- Revision received September 4, 2013.
- Accepted September 10, 2013.