PMID- 22365425
OWN - NLM
STAT- MEDLINE
DCOM- 20120710
LR  - 20220331
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 59
IP  - 18
DP  - 2012 May 1
TI  - Long-term follow-up of biopsy-proven viral myocarditis: predictors of mortality 
      and incomplete recovery.
PG  - 1604-15
LID - 10.1016/j.jacc.2012.01.007 [doi]
AB  - OBJECTIVES: This study sought to evaluate the long-term mortality in patients 
      with viral myocarditis, and to establish the prognostic value of various 
      clinical, functional, and cardiovascular magnetic resonance (CMR) parameters. 
      BACKGROUND: Long-term mortality of viral myocarditis, as well as potential risk 
      factors for poor clinical outcome, are widely unknown. METHODS: A total of 222 
      consecutive patients with biopsy-proven viral myocarditis and CMR were enrolled. 
      A total of 203 patients were available for clinical follow-up, and 77 patients 
      underwent additional follow-up CMR. The median follow-up was 4.7 years. Primary 
      endpoints were all-cause mortality and cardiac mortality. RESULTS: We found a 
      relevant long-term mortality in myocarditis patients (19.2% all cause, 15% 
      cardiac, and 9.9% sudden cardiac death [SCD]). The presence of late gadolinium 
      enhancement (LGE) yields a hazard ratio of 8.4 for all-cause mortality and 12.8 
      for cardiac mortality, independent of clinical symptoms. This is superior to 
      parameters like left ventricular (LV) ejection fraction, LV end-diastolic volume, 
      or New York Heart Association (NYHA) functional class, yielding hazard ratios 
      between 1.0 and 3.2 for all-cause mortality and between 1.0 and 2.2 for cardiac 
      mortality. No patient without LGE experienced SCD, even if the LV was enlarged 
      and impaired. When focusing on the subgroup undergoing follow-up CMR, we found an 
      initial NYHA functional class >I as the best independent predictor for incomplete 
      recovery (p = 0.03). CONCLUSIONS: Among our population with a wide range of 
      clinical symptoms, biopsy-proven viral myocarditis is associated with a long-term 
      mortality of up to 19.2% in 4.7 years. In addition, the presence of LGE is the 
      best independent predictor of all-cause mortality and of cardiac mortality. 
      Furthermore, initial presentation with heart failure may be a good predictor of 
      incomplete long-term recovery.
CI  - Copyright (c) 2012 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Grun, Stefan
AU  - Grun S
AD  - Department of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 
      Stuttgart, Germany.
FAU - Schumm, Julia
AU  - Schumm J
FAU - Greulich, Simon
AU  - Greulich S
FAU - Wagner, Anja
AU  - Wagner A
FAU - Schneider, Steffen
AU  - Schneider S
FAU - Bruder, Oliver
AU  - Bruder O
FAU - Kispert, Eva-Maria
AU  - Kispert EM
FAU - Hill, Stephan
AU  - Hill S
FAU - Ong, Peter
AU  - Ong P
FAU - Klingel, Karin
AU  - Klingel K
FAU - Kandolf, Reinhardt
AU  - Kandolf R
FAU - Sechtem, Udo
AU  - Sechtem U
FAU - Mahrholdt, Heiko
AU  - Mahrholdt H
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20120222
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
SB  - IM
MH  - Adult
MH  - Biopsy/*methods
MH  - Cardiovascular Infections/mortality/*pathology/virology
MH  - Cause of Death/trends
MH  - Electrocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Germany/epidemiology
MH  - Humans
MH  - Magnetic Resonance Imaging, Cine
MH  - Male
MH  - Middle Aged
MH  - Myocarditis/mortality/*pathology/virology
MH  - Myocardium/*pathology
MH  - Prognosis
MH  - *Recovery of Function
MH  - Retrospective Studies
MH  - Risk Assessment/*methods
MH  - Survival Rate/trends
MH  - Time Factors
MH  - Virus Diseases/mortality/*pathology/virology
EDAT- 2012/03/01 06:00
MHDA- 2012/07/11 06:00
CRDT- 2012/02/28 06:00
PHST- 2011/10/11 00:00 [received]
PHST- 2011/12/20 00:00 [revised]
PHST- 2012/01/02 00:00 [accepted]
PHST- 2012/02/28 06:00 [entrez]
PHST- 2012/03/01 06:00 [pubmed]
PHST- 2012/07/11 06:00 [medline]
AID - S0735-1097(12)00158-1 [pii]
AID - 10.1016/j.jacc.2012.01.007 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2012 May 1;59(18):1604-15. doi: 10.1016/j.jacc.2012.01.007. 
      Epub 2012 Feb 22.