Clinical profiling and Outcomes of Viral Myocarditis manifesting with Ventricular Arrhythmias

G. Peretto, Simone Sala, E. Carturan, Stefania Rizzo, A. Villatore, G. de Luca, C. Campochiaro, A. Palmisano, D. Vignale, M. De Gaspari, L. Dagna, Antonio Esposito, Cristina Basso, P. Camici, P. Della Bella
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Abstract

Clinical features and risk stratification of patients with viral myocarditis (VM) complicated by ventricular arrhythmias (VA) are incompletely understood. We aim to describe arrhythmia patterns and outcomes in patients with VM and early-onset VA. We present a single center study, enrolling patients with VM proven by endomyocardial biopsy, and evidence of VA within 24 hours of hospitalization. The incidence of major adverse events (MAE), including all-cause death, severe heart failure, advanced atrioventricular blocks, or major VA, was evaluated during a 24-month follow-up (FU), and compared with a matched group of virus-negative myocarditis. Of patients with VM (n=74, mean age 47±16 years, 66% males, LVEF 51±13%), 20 (27%) presented with major VA (VT/VF), and 32 (44%) had polymorphic VA. Patients with polymorphic VA more commonly had evidence of ongoing systemic infection (24/32 vs. 10/42, p=0.004) and experienced greater occurrence of MAE at discharge (15/32 vs. 2/42, p<0.001). However, the incidence of MAE during FU was higher in patients with monomorphic VA compared to those with polymorphic VA (17/42 vs. 2/28, p=0.002). Patients with monomorphic VA displayed frequently signs of chronic cardiomyopathy, and had outcomes comparable with virus-negative myocarditis (Log rank p=0.929). Presentation with VT/VF was independently associated with MAE (at discharge: HR 4.7, 95%CI 1.6-14.0, p=0.005; during FU: HR 6.3, 95%CI 2.3-17.6, p<0.001). In patients with VM, polymorphic VA point to ongoing systemic infection and early adverse outcomes, whereas monomorphic VA suggest chronic cardiomyopathy and greater incidence of MAE during FU. Presentation with VT/VF is independently associated with MAE.
表现为室性心律失常的病毒性心肌炎的临床特征和治疗结果
病毒性心肌炎(VM)合并室性心律失常(VA)患者的临床特征和危险分层尚不完全清楚。我们的目的是描述室性心律失常和早发性室性心律失常患者的心律失常模式和结果。我们提出了一项单中心研究,纳入了经心内膜心肌活检证实的室性心律失常患者,并在住院24小时内有室性心律失常的证据。在24个月的随访(FU)期间评估主要不良事件(MAE)的发生率,包括全因死亡、严重心力衰竭、晚期房室传导阻滞或严重房颤(VA),并与匹配的病毒阴性心肌炎组进行比较。VM患者(n=74,平均年龄47±16岁,男性占66%,LVEF为51±13%)中,20例(27%)表现为重度VA (VT/VF), 32例(44%)表现为多形性VA。多形性VA患者通常有持续的全身感染(24/32比10/42,p=0.004),出院时MAE的发生率更高(15/32比2/42,p<0.001)。然而,单型VA患者在FU期间MAE的发生率高于多型VA患者(17/42比2/28,p=0.002)。单型心肌炎患者经常表现出慢性心肌病的体征,其结果与病毒阴性心肌炎相当(Log rank p=0.929)。VT/VF的表现与MAE独立相关(出院时:HR 4.7, 95%CI 1.6-14.0, p=0.005;FU期间:HR 6.3, 95%CI 2.3 ~ 17.6, p<0.001)。在VM患者中,多形态VA表明持续的全身感染和早期不良后果,而单形态VA表明慢性心肌病和FU期间MAE的发生率更高。VT/VF的表现与MAE独立相关。
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CiteScore
2.80
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