Contemporary Epidemiology, Management, and In-Hospital Outcomes of Acute Myocarditis

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure Pub Date : 2025-06-13 DOI:10.1016/j.jchf.2025.03.038

Claire Bouleti MD, PhD , Theodora Bejan-Angoulvant MD, PhD , Clement Servoz MD , Ehmer Carsten MD , Thibaud Genet MD , Julien Ternacle MD, PhD , Jean-François Deux MD, PhD , Etienne Puymirat MD, PhD , Elie Mousseaux MD, PhD , Benjamin Alos MD , Rodrigue Garcia MD, PhD , Guillaume Bonnet MD , Alexis Jacquier MD, PhD , Benoit Lattuca MD, PhD , Olivier Huttin MD, PhD , Mariama Akodad MD, PhD , Alban Redheuil MD, PhD , Denis Angoulvant MD, PhD , Phalla Ou MD, PhD , Cyrille Boulogne

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引用次数: 0

Abstract

Background

Despite a frequently favorable evolution during the initial phase, acute myocarditis (AM) remains associated with heart failure and ventricular arrhythmia. There are no large prospective databases to provide robust results.

Objectives

The aim of this study was to describe baseline characteristics, real-life management, in-hospital outcomes, and determinants of prognosis in a large cohort of patients with AM admitted to cardiology, with a comparison of patients with and without initial severity criteria.

Methods

MyocarditIRM (French National Observatory Tracking Viral Myocarditis: Mortality, Cardiovascular Events, Sequels on [Magnetic Resonance Imaging] MRI) is a multicenter prospective observational study of patients with AM confirmed by cardiac magnetic resonance. Patients initially admitted to the intensive care unit or those who died before cardiac magnetic resonance–confirmed diagnosis were not included.

Results

In total, 803 consecutive hospitalized patients were enrolled at 49 participating centers between May 2016 and February 2019. The median age was 31 years (Q1-Q3: 23-41 years), and 82% were men. Chest pain was the most frequent symptom (93%), and 112 patients (14%) had severity criteria upon admission (left ventricular ejection fraction <50%, severe ventricular arrythmia, high-degree atrioventricular block, or cardiogenic shock). ST-segment elevation was observed in 49% of patients. Overall, 64 patients (8%) experienced in-hospital complications, defined as a composite of death; left ventricular ejection fraction ≤40%; sustained ventricular or supraventricular arrythmia; cardiogenic shock; and need for mechanical circulatory support, inotropic drugs, temporary cardiac pacing, pacemaker, or cardiac defibrillator implantation. Patients with severity criteria at admission were 10 times more likely to experience in-hospital complications.

Conclusions

This prospective cohort represents the largest AM database worldwide. Although the recruitment process likely led to a selection of patients with lower risk AM, 8% experienced in-hospital complications, the major prognosis factor being severity criteria upon admission. (French National Observatory Tracking Viral Myocarditis: Mortality, Cardiovascular Events, Sequels on (Magnetic Resonance Imaging) MRI; NCT02717143)

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急性心肌炎的当代流行病学、管理和住院结果

背景：尽管急性心肌炎（AM）在初始阶段往往是有利的，但它仍然与心力衰竭和室性心律失常有关。没有大型的前瞻性数据库来提供可靠的结果。目的：本研究的目的是描述一大批心脏病学住院的AM患者的基线特征、现实生活管理、住院结果和预后决定因素，并对有和没有初始严重程度标准的患者进行比较。方法yoccarditirm（法国国家观测站追踪病毒性心肌炎：死亡率、心血管事件、[磁共振成像]MRI后遗症）是一项多中心前瞻性观察研究，研究对象为经心脏磁共振确诊的AM患者。最初入住重症监护室的患者或在心脏磁共振确诊前死亡的患者不包括在内。结果2016年5月至2019年2月，共纳入49个参与中心的803例连续住院患者。中位年龄为31岁（Q1-Q3: 23-41岁），82%为男性。胸痛是最常见的症状（93%），112例患者（14%）在入院时有严重程度标准（左室射血分数50%，严重室性心律失常，高度房室传导阻滞或心源性休克）。49%的患者出现st段抬高。总体而言，64名患者（8%）经历了院内并发症，定义为复合死亡；左室射血分数≤40%;持续性室性或室上性心律失常；心原性休克;并且需要机械循环支持、肌力药物、临时心脏起搏、起搏器或心脏除颤器植入。入院时具有严重程度标准的患者出现院内并发症的可能性高出10倍。该前瞻性队列代表了全球最大的AM数据库。虽然招募过程可能导致选择风险较低的AM患者，但8%的患者出现了院内并发症，主要预后因素是入院时的严重程度标准。法国国家观测站跟踪病毒性心肌炎：死亡率，心血管事件，（磁共振成像）MRI的后遗症；NCT02717143)

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来源期刊

JACC. Heart failure CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

21.20

自引率

2.30%

发文量

164

期刊介绍： JACC: Heart Failure publishes crucial findings on the pathophysiology, diagnosis, treatment, and care of heart failure patients. The goal is to enhance understanding through timely scientific communication on disease, clinical trials, outcomes, and therapeutic advances. The Journal fosters interdisciplinary connections with neuroscience, pulmonary medicine, nephrology, electrophysiology, and surgery related to heart failure. It also covers articles on pharmacogenetics, biomarkers, and metabolomics.